微波消融治疗原发性甲状旁腺功能亢进症失败的原因分析

Analysis of the causes of the failure of microwave ablation in the treatment of primary hyperparathyroidism

目的探讨微波消融治疗原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)失败的原因及处理措施。方法治疗失败定义为消融术后6个月血清全段甲状旁腺激素(iPTH)和/或血钙未持续恢复正常。对2015年1月至2019年2月在中日友好医院微波消融治疗失败的5例PHPT患者的病例资料进行分析和处理。结果消融术后6个月,5例患者的血清iPTH未恢复正常,其中1例患者伴有血钙未恢复正常。3例患者的病灶成功消融,但是存在维生素D缺乏,给予维生素D3治疗后血清iPTH恢复正常;2例患者的病灶消融不成功,其病灶分别为0.8cm和4.7cm,给予再次消融后血清iPTH均恢复正常。结论微波消融可以有效治疗PHPT,但维生素D缺乏、病灶体积过大或过小可能导致治疗失败。在临床工作中,应该明确PHPT的病因及发展规律,注重消融技术的细节,以提高治疗成功率。

Objective To explore the failure reasons and treatment measures of microwave ablation for primary hyperparathyroidism(PHPT). Method Treatment failure was defined as the failure of serum intact parathyroid hormone(iPTH) and/or blood calcium to return to normal 6 months after ablation. Five patients who failed microwave ablation treatment were analyzed and treated. Result Six months after the ablation, the serum iPTH of 5 patients did not return to normal, and 1 patient with blood calcium did not return to normal. The lesions of 3 patients were successfully ablated, but there was vitamin D deficiency, and the serum iPTH returned to normal after treatment with vitamin D3.The lesions of 2 patients were not successfully ablated. The lesions were 0.8 cm and 4.7 cm, respectively. After re-ablation, the serum iPTH returned to normal. Conclusion Microwave ablation can effectively treat PHPT, but vitamin D deficiency, too large or too small lesions may lead to treatment failure. In clinical work, we should clarify the etiology and development rules of PHPT, and pay attention to the details of ablation technology to improve the success rate of treatment.