维持性血液透析合并继发性甲状旁腺功能亢进患者甲状旁腺全切术后疗效及复发原因分析

Analysis of curative effect and recurrence factors after total parathyroidectomy for secondary hyperparathyroidism

目的探讨继发性甲状旁腺功能亢进(SHPT)的维持性血液透析(MHD)患者行甲状旁腺全切术(t PTX)后的疗效及复发原因。方法我院确诊为SHPT行t PTX的MHD患者28例,分析术后血钙、血磷、甲状旁腺激素(i PTH)变化及症状改善情况;比较SHPT术后复发和无复发患者术前透析龄、血钙、血磷、血碱性磷酸酶、i PTH的差异。结果 28例SHPT患者t PTX后第1、4、12、24周血钙、血磷、i PTH均较术前降低(P<0.001);术前伴发相关症状(骨痛、关节疼痛、行走困难、顽固性贫血、皮肤瘙痒等) 23例(82.1%),术后24周伴发相关症状9例(32.1%),差异有统计学意义(P<0.05);复发患者术前i PTH高于无复发患者(P<0.05)。结论 t PTX是治疗难治性SHPT的有效方式,可降低过高i PTH,改善患者症状;对于术前i PTH水平较高的患者,术后复发概率可能更高,应注意术前精准定位,术中对残余甲状旁腺组织的清除。

Objective To explore the efficacy of total parathyroidectomy(t PTX)due to the secondary hyperparathyroidism(SHPT)in maintenance hemodialysis(MHD)patients and the causes of recurrence.Methods Twenty-eight MHD patients diagnosed with SHPT and treated with t PTX in our hospital were analyzed.Thechanges in serum calcium,serum phosphorus,intact parathyroid hormone(i PTH)and symptom improvement were analyzed.Age of preoperative dialysis,serum calcium,serum phosphorus,serum alkaline phosphatase and intact parathyroid hormone(i PTH)in patients with and without SHPT recurrence were compared.Results The serum calcium,serum phosphorus,and i PTH of the 28 SHPT patients after 1 week,4,12 and 24 weeks of t PTX were lower than those before t PTX(P<0.001).Preoperative symptoms such as bone pain,joint pain,difficulty in walking,intractable anemia,and pruritus were found in 23 cases(82.1%),and there were 9 cases with the related symptoms found after 24 weeks of surgery(32.1%)(P<0.05).Preoperative i PTH in recurrent patients was higher than that in non-recurrent patients(P<0.05).Conclusion t PTX is an effective way to treat refractory SHPT.It can reduce the high i PTH level and improve the symptoms of patients.For patients with higher preoperative i PTH level,the probability of postoperative recurrence may be higher.Attention should be paid to precise preoperative positioning and intraoperative removal of residual parathyroid tissue.