维持透析患者继发性行甲状旁腺功能亢进手术治疗疗效分析

The therapeutic evaluation of parathyroidectomy on maintenance dialysis patients suffering from secondary hyperparathyroidism

目的观察维持透析患者继发性甲状旁腺功能亢进症行甲状旁腺切除术治疗的临床疗效和分析手术后复发情况。方法回顾性分析本院201 3年至201 7年维持透析患者因继发性甲状旁腺功能亢进行甲状旁腺切除术治疗的手术方式、术前、术后血钙、血磷和全段甲状旁腺激素(iPTH)变化,统计手术成功率、持续继发性甲状旁腺功能亢进率、持续继发性甲状旁腺功能低下率及继发性甲状旁腺功能亢进术后复发率。结果本院维持透析患者行甲状旁腺切除手术患者共112例,随访完整的患者53例。术后各时间点血钙、血磷、血iPTH均较术前降低(P<0.05)。继发性甲状旁腺功能亢进手术成功率为100%,持续继发性甲状旁腺功能亢进率为13.20%,持续继发性甲状旁腺功能减低率为3.03%,手术后复发率为22.90%。结论甲状旁腺切除手术可有效治疗维持透析患者继发性甲状旁腺功能亢进,手术成功率高,但存在一定程度复发或持续继发性甲状旁腺亢进或持续继发性甲状旁腺功能减退风险。

Objective To observe the clinical curative effect of parathyroidectomy on the maintenance dialysis patients suffering from secondary hyperparathyroidism and to analyze the recurrence after parathyroidectomy. Methods Retrospective analysis of the surgical methods and the changes of intact parathyroid hormone ( iPTH ), blood calcium and blood phosphate on m aintenance dialysis patients who underwent parathyroidectomy for secondary hyperparathyroidism from 2013 to 2017 in our hospital was performed. The success rate of surgery, postoperative persistent hyperparathyroidism ra te , postoperative persistent hypoparathyroidism rate, recurrence rate were also calculated. Results From 2013 to 2017 , 112 m aintenance dialysis patients underwent parathyroidectomy in our hospital. Fiftythree of them had complete follow-up data. The iPTH , blood calcium and phosphate decreased significantly after parathyroidectomy ( P < 0.05 ). The success rate of surgery was 100%. The postoperative persistent hyperparathyroidism rate was 13. 2 %. The postoperative persistent hypoparathyroidism rate was 3.03 %. The recurrence rate was 22.9%. Conclusions The parathyroidectomy can effectively treat secondary hyperparathyroidism in m aintenance dialysis patients. The success rate of surgery is high. How ever, there is a risk of recurrent or persistent secondary hyperparathyroidism or persistent secondary hypoparathyroidism.