尿毒症继发性甲状旁腺功能亢进症术后复发再手术治疗探讨

Reoperation for postoperative recurrence of secondary hyperparathyroidism

目的探讨尿毒症继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)术后复发再手术治疗的手术方式及效果。方法对10例尿毒症SHPT术后复发患者的临床资料进行回顾性分析,对比患者手术前后症状、血清全段甲状旁腺素(i PTH)、血钙血磷等变化,总结其手术效果及手术并发症等临床资料。结果 10例患者行颈部遗留甲状旁腺全切和自体前臂移植甲状旁腺切除术,术后患者骨痛及皮肤瘙痒症状消失,与术前比较,术后血i PTH、血钙、血磷水平均显著降低(P<0.05)。随访6个月,无复发。结论尿毒症SHPT术后复发再手术治疗效果良好,术前定位应联合各种影像学定位,术前手术医生与影像学医生充分沟通,手术应切除全部残留甲状旁腺组织,避免SHPT反复发作。

Objective To explore the operative method and effect of reoperation on postoperative recurrence of secondary hyperparathyroidism(SHPT)in the patients with uremia.Methods The clinical data of10uremia patients with postoperative recurrence of SHPT were retrospectively analyzed.The clinical symptoms,the levels of serum intact parathyroid hormone(iPTH),blood calcium and blood phosphorus,and the reoperation outcomes and complications were compared before and after the surgery.Results Parathyroidectomy of neck remnants and parathyroidectomy with autologous forearm transplantation were performed on the10patients.The symptoms of osteodynia and skin itch disappeared in the patients after surgery.Compared with those before surgery,the levels of iPTH,blood calcium and blood phosphorus were significantly reduced after surgery(P<0.05).No recurrence was found after6months of follow-up.Conclusion Reoperation is effective for postoperative recurrence of secondary hyperparathyroidism in the patients with uremia.Preoperative localization should be combined with various imaging positionings and all the residual parathyroid tissues should be removed to avoid repeated episodes of SHPT.