行甲状旁腺全切术的265例继发性甲状旁腺功能亢进症的临床特征分析

Clinical analysis of the 265 secondary hyperparathyroidism cases treated with total parathyroidectomy

目的分析行甲状旁腺全切术(total parathyroidectomy,t-PTX)的265例继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)的临床特征。方法回顾性总结分析北部战区总医院肝胆外科2018年1月~2019年12月行t-PTX术的SHPT患者,统计其临床表现、检查检验结果、病理结果等。结果265例患者中SHPT病程(3.07±2.13)年,有5例异位旁腺(1.89%),切除4枚旁腺220例(83.02%),术后病理提示结节样增生182例、腺瘤样增生6例、二者结合64例,218例患者术后出现低钙血症(82.26%),住院期间静脉高浓度补钙(557.86±376.20)ml,术后6例复发(22.64%),围手术期死亡2例(0.75%),术前甲状旁腺激素(parathormone,PTH)(1729.15±345.18)pg/ml、血清钙(calcium,CA)(2.43±0.19)mmol/L、磷(phosphore,P)(2.38±0.52)mmol/L,术中PTH(286.97±179.25)pg/ml,术后PTH、CA、P水平均较术前显著降低(t值分别为6.630,-2.965,-3.412;P值分别为<0.001,0.005,0.001)。246人存在骨痛(2.30±1.95)年,骨痛评分(5.08±2.65)分;骨密度测量34例(12.83%)骨量正常、105例(39.62%)骨量减少、126例(47.55%)骨质疏松;197人(74.34%)存在瘙痒(2.13±1.25)年,瘙痒评分(3.58±1.19)分,术后6月骨痛、瘙痒评分明显改善(t值分别为7.897,2.542;P值分别为<0.001,0.014)。结论t-PTX是治疗SHPT的安全有效的方法,多数SHPT患者骨痛、瘙痒严重,以结节样病变为主,术后可明显改善,可发生严重低钙血症,在治疗中应予以重视。

Objective To analyze the clinical characteristics of the 265 secondary hyperparathyroidism(SHPT)patients who underwent total parathyroidectomy(t-PTX).Methods Clinical manifestations,laboratory results and pathological changes of the SHPT patients who underwent t-PTX from January 2018 to December 2019 were retrospectively analyzed.Results In the 265 patients,the SHPT lasted 1-9(3.07±2.13)years,5 had heterotopic paraglands(1.89%),220 had 4 paraglands removed(83.02%),182 had nodular hyperplasia,6 had adenomatous hyperplasia,and 64 had both types of hyperplasia.After operation,218 patients developed hypocalcemia(82.26%).During hospitalization,557.86±376.20 ml of higher concentration calcium was supplemented intravenously.After operation,6 patients recurred(22.64%),and 2 patients died in peri-operation period(0.75%).Before operation,serum PTH was 588~2934(1729.15±345.18)pg/ml,Ca was 1.95~2.93(2.43±0.19)mmol/L,and P was 1.3~3.59(2.38±0.52)mmol/L;during operation,PTH decreased to 49.00~895.00(286.97±179.25)pg/ml;after operation,PTH,CA and P levels decreased significantly(t=6.630,-2.965 and-3.412 respectively;P<0.001,0.005 and 0.001 respectively).Bone pain was found in 246 patients(92.83%),with the bone pain course of 0~8 years(2.30±1.95)years and bone pain score of 0~10(5.08±2.65)points.Bone density measurement found normal bone mass in 34 patients(12.83%),lower bone mass in 105 patients(39.62%),and osteoporosis in 126 patients(47.55%).Skin itch was found in 197 patients(74.34%),with the itch course of 0~8 years(2.13±1.25)years and itch score of 0~10(3.58±1.19)points.After operation 6 morrths,bone pain and itch improved significantly(t=7.897 and 2.542 respectively;P<0.001 and 0.014 respectively).Conclusions t-PTX is a safe and effective method to treat SHPT.Most SHPT patients have severe bone pain and itching.The pathological changes of parathyroids were mainly nodular lesions.SHPT can be significantly improved by t-PTX surgery.Severe hypocalcemia may occur after surgery,which should be carefully monitored.