甲状旁腺切除术对尿毒症继发甲状旁腺功能亢进症的治疗效果

Therapeutic Effect of Parathyroidectomy on Patients with Uremia and Secondary Hyperparathyroidism

目的:观察甲状旁腺切除术(PTX)对维持性血液透析(MHD)尿毒症继发甲状旁腺功能亢进症(SHPT)患者临床症状及血液生化指标的影响。方法:58例MHD接受PTX的尿毒症继发SHPT患者,采用甲状旁腺全切加前臂自体移植术(tPTX+AT,≥4个)或甲状旁腺全切术(tPTX,<4个;切除的甲状旁腺不移植)进行治疗;比较两组患者手术前后骨痛、肌无力、皮肤瘙痒、失眠及不宁腿综合征症状改善情况和术后的治疗效果;比较术前及术后第1周、第3、6个月时患者血清全段甲状旁腺激素(iPTH)、钙(Ca)、磷(P)及碱性磷酸酶(AKP)水平,比较两组患者血红蛋白(Hb)含量、收缩压(SBP)及舒张压(DBP)。结果:58例尿毒症继发SHPT患者,行tPTX+AT46例(79.3%)、tPTX12例(20.7%),治愈57例(98.3%)、显效1例(1.7%)及复发1例(1.7%),术后围手术期无死亡病例;治疗后,术前42例骨痛、20例皮肤瘙痒患者症状均全部缓解(100%),14例失眠、36例肌无力、22例不宁腿综合征患者症状均全部改善(100%);与治疗前比较,术后患者血清iPTH、Ca、P及AKP水平显著下降(P<0.05),Hb水平显著升高(P<0.05)、SBP及DBP显著下降(P<0.05)。结论:PTX治疗MHD尿毒症继发SHPT是一种安全有效的手段,能有效缓解患者临床症状。

Objective: To observe the effect of parathyroidectomy (PTX) on clinical symptoms and blood biochemical parameters in patients with uremia and secondary hyperparathyroidism (SHPT),who were given maintenance hemodialysis (MHD). Methods: Fifty-eight patients with uremia and SHPT under MHD treatment were accepted different PTX schemes based on the number of parathyroid glands required for removal: total PTX plus forearm autograft (tPTX+AT group),total PTX (tPTX group).Bone pain,muscle weakness,itchy skin,insomnia and restless legs syndrome before and after surgery were compared between the two groups.Serum total parathyroid hormone (iPTH),calcium (Ca),phosphorus (P) and alkaline phosphatase (AKP) levels were measured at the first week,the third week and 6 months after the surgery.The hemoglobin (Hb) levels,systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured. Results: Forty-six patients (46/58,79.3%) were given with tPTX+AT and 12 patients (20.7%) with tPTX.57 patients (98.3%) were cured,and 1 patient (1.7%) had obvious response,but one of them relapsed (1.7%).There was no death during perio- perative period.Bone pain in 42 patients and pruritus in 20 patients were completely relieved (100%),and insomnia,muscle weakness and leg syndrome were all improved (100%).The levels of serum iPTH,Ca,P,AKP,SBP and DBP were significantly decreased ( P <0.05),while hemoglobin levels were significantly increased ( P <0.05). Conclusion: PTX is a safe and effective method for the treatment of patients with uremia and SHPT under MHD.It can effectively alleviate the clinical symptoms of patients.