16例继发性甲状旁腺功能亢进患者行甲状旁腺切除术后复发再次手术的临床分析

Re-operation after parathyroidectomy for the recurrence of the secondary hyperparathyroidism,clinical analysis of 16 cases

目的分析16例继发性甲状旁腺功能亢进(SHPT)患者行甲状旁腺切除术后复发再次手术的临床应用效果。方法回顾性分析2017年5月至2019年10月接受再次手术的16例SHPT行甲状旁腺切除术后复发患者临床资料,采用SPSS22.0软件进行数据处理,甲状旁腺体积、实验室指标、生存质量(WHOQOL-BREF)以(±s)表示,采用配对样本t检验;手术成功率、症状改善情况及并发症采用χ^2检验,P<0.05为差异有统计学意义。结果16例患者手术成功15例,手术成功率为93.75%;相比术前,患者术后6个月的皮肤瘙痒、骨痛、骨折或骨骼畸形、肌无力伴萎缩及异位钙化发生率较低,甲状旁腺体积、血清全段甲状旁腺激素(iPTH)、血钙(Ca)及磷(P)水平均较低,WHOQOL-BREF各维度评分均较高,差异有统计学意义(P<0.05);16例患者均未见手脚抽搐、术区出血、呼吸困难及骨饥饿综合征等并发症,5例出现低钙血症,1例出现短暂性进食呛咳。结论针对甲状旁腺切除术后复发的SHPT再次手术治疗的成功率高、并发症少,可促进临床症状改善及消失,降低血清iPTH水平,避免遗留甲状旁腺,改善生活质量。

Objective To analyze the clinical outcome of reoperation after parathyroidectomy for the recurrence of the secondary hyperparathyroidism in 16 patients.Methods The clinical data of 16 patients with recurrent secondary hyperparathyroidism after parathyroidectomy,who underwent reoperation from May 2017 to October 2019,were analyzed retrospectively.Statistical analysis were performed by using SPSS 22.0 software.Measurement data,such as Parathyroid volume,laboratory parameters,and quality of WHOQOL-BREF were expressed as,and were examined by using paired sample t test.Surgical success rate,symptom improvement and postoperative complications were analyzed by usingχ^2 test A P value<0.05 was considered as statistically significant difference.Results 15 of 16 patients(93.75%)received successful surgery.Compared with the preoperative period,patients'complains of skin pruritus,bone pain,fracture or bone deformity,muscle weakness with atrophy and ectopic calcification was much lower at 6 months after operation.Blood calcium(Ca)and phosphorus(P)levels are low,WHOQOL-BREF scores are high in all dimensions,with significant difference(P<0.05).There were no complications of hand and foot twitching,bleeding in the operation area,dyspnea and bone hunger syndrome in 16 patients.Hypocalcemia occurred in 5 cases,while short-term eating cough occurred in 1 case.Conclusion For the recurrence of secondary hyperparathyroidism after parathyroidectomy,the success rate of reoperation is pretty good with low complications,which could promote the improvement and disappearance of clinical symptoms,including reducing the serum iPTH level,avoiding the residual parathyroid glands,with improved life quality.