射频消融术(RFA)治疗继发性甲状旁腺功能亢进(SHPT)的安全性及有效性分析

The safety and efficacy of ultrasound guided percutaneous radiofrequency ablation(RFA)for secondary hyperparathyroidism(SHPT)

目的探讨超声引导下射频消融术治疗慢性肾脏病(chronic kidney disease,CKD)继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的安全性及有效性。方法选取复旦大学附属中山医院2017年10月至2018年9月确诊为SHPT并进行超声引导下射频消融术(radiofrequency ablatio,RFA)的患者15例,共15枚甲状旁腺增生结节,以超声造影作为测量消融术前后甲状旁腺结节大小的标准方法。对比消融术前后甲状旁腺结节大小、甲状旁腺激素(parathyroid hormone,PTH)、血钙(Ca)、血磷(P)、碱性磷酸酶(alkaline phosphatase,ALP)、活性维生素D[1,25-(OH)2D]、临床症状(骨痛、皮肤瘙痒、失眠、手抖)及并发症情况。结果与消融术前比较,患者术后1、3和6个月甲状旁腺结节明显变小(P<0.05),结节缩小率分别为66%、93%和98%,术后1天、1、3和6个月血清PTH、Ca、P、ALP水平明显下降(P<0.05),活性维生素D水平无明显改变,患者的临床症状明显好转。并发症声音嘶哑的发生率为6.7%,低钙血症的发生率6.7%,治疗后均恢复,且未再复发,无其他并发症。结论超声引导下经皮RFA治疗SHPT安全有效,能明显改善患者症状,且并发症较少。

Objective To explore the safety and efficacy of ultrasound guided percutaneous radiofrequency ablation(RFA)in the treatment of secondary hyperparathyroidism(SHPT).Methods Fifteen patients of SHPT with a total of 15 hyperplastic parathyroid nodules who came from Zhongshan Hospital,Fudan University in the period of Oct.2017 to Sep.2018 were treated with ultrasound guided percutaneous radiofrequency ablation(RFA).The nodules were evaluated by contrast enhanced ultrasound before and after RFA.The parathyroid nodule volumes,the levels of serum parathyroid hormone(PTH),calcium(Ca),phosphorus(P),alkaline phosphatase(ALP),1,25-Dihydroxy vitamin D,the clinical symptoms(including osteoarticular pain,skin pruritus,insomnia and hands shaking)and complications were compared after surgery before and after RFA.Results The nodule volumes were significantly reduced at 1,3,6 month after surgery(P<0.05),with volume reduction rate of 66%,93%and 98%,respectively.Serum PTH,Ca,P and ALP decreased significantly(P<0.05),while no significant difference was found in 1,25-Dihydroxy vitamin D.The clinical symptoms of patients were significantly improved,while hoarseness rate reached 6.7%and hypocalcemia rate reached 6.7%,which all recovered after treatment without recurrence and no other complications occurred.Conclusion Ultrasound guided percutaneous RFA is a kind of safe and effective method for the treatment of SHPT,which can improve the symptoms significantly with fewer complications.