甲状旁腺全切术联合自体前臂移植术治疗肾功能衰竭继发性甲状旁腺功能亢进的疗效

Total parathyroidectomy combined with autogenous forearm transplantation in the treatment of renal failure secondary hyperparathyroidism

目的探讨甲状旁腺全切术联合自体前臂移植术治疗肾功能衰竭继发性甲状旁腺功能亢进的效果及对患者血钙、甲旁素变化的影响。方法选取2013年5月~2017年5月我院收治的肾功能衰竭继发性甲状旁腺功能亢进患者100例,随机分为对照组和研究组两组,每组各50例,对照组应用甲状旁腺次全切术治疗,研究组应用甲状旁腺全切术联合前臂移植术治疗。观察患者术前、术后6个月临床症状改善情况,检测血钙、血磷及甲旁素水平、碱性磷酸酶(ALP)、血红蛋白(HGB)及血白蛋白(ALB)的水平变化,并对两组患者术前及术后6个月的生活质量进行评估。结果治疗后,两组患者皮肤瘙痒、骨关节疼痛、不宁腿综合症以及异位钙化发生率与治疗前比较差异均有统计学意义(P<0.05),但观察组与治疗组比较差异无统计学意义(P>0.05);治疗前两组血钙、血磷及甲状旁腺激素水平、ALP、HGB、ALB相比较差异均无统计学意义(P>0.05),治疗后,研究组血磷水平、ALP、HGB、ALB与对照组相比差异均无统计学意义(P>0.05),但血钙、甲状旁腺激素水平研究组明显高于对照组(P<0.05),研究组ALP与对照组比较明显下降(P<0.05);治疗前研究组角色功能、认知功能、躯体功能以及社会功能得分与对照组比较无明显差异(P>0.05),治疗后研究组角色功能、认知功能、躯体功能以及社会功能得分高于对照组(P<0.05)。结论在肾功能衰竭继发性甲状旁腺功能亢进的治疗过程当中,甲状旁腺全切术联合前臂移植术的治疗效果理想,可改善患者血钙、甲状旁腺激素水平、ALP,提高患者生活质量,值得临床医师借鉴。

Objective To explore the effect of total parathyroidectomy combined with autogenous forearm transplantation on secondary hyperparathyroidism of renal failure and the change of serum calcium and parathyroid hormone. Methods From May 2013 to may 2017, 100 patients with secondary hyperparathyroidism due to renal failure were randomly divided into the control group and the study group, with 50 cases in each group. The control group was treated with subtotal parathyroidectomy. The study group was treated with parathyroidectomy and forearm transplantation. The improvement of clinical symptoms was observed before and 6 months after operation. The levels of serum calcium, phosphorus, parathyroid hormone, alkaline phosphatase(ALP), hemoglobin(Hgb) and albumin(ALB) were measured. The quality of life of the two groups before and 6 months after operation was evaluated. Results After treatment, the incidence of skin pruritus, bone and joint pain, restless legs syndrome and ectopic calcification in the two groups were statistically significant(P<0.05), but there was no significant difference between the observation group and the treatment group(P>0.05). There was no significant difference in serum calcium, phosphorus, parathyroid hormone, ALP, HGB and ALB between the two groups before treatment(P>0.05). After treatment, there was no significant difference in blood phosphorus level, ALP, HGB and ALB between the study group and the control group(P>0.05), but the level of blood calcium and parathyroid hormone in the study group was significantly higher than that in the control group(P<0.05). ALP in the study group was significantly lower than that in the control group(P<0.05). Before treatment, there was no significant difference in the scores of role function, cognitive function, physical function and social function between the study group and the control group(P>0.05). After treatment, the scores of role function, cognitive function, physical function and social function in the study group were higher than those in the control group(P<0.05). Conclusion In the treatment of hyperparathyroidism secondary to renal failure, total parathyroidectomy combined with forearm transplantation has an ideal therapeutic effect, which can improve the level of blood calcium, parathyroid hormone, ALP, and the quality of life of patients, and it is worthy of reference for clinicians.