不同术前甲状旁腺定位法在维持性血液透析SHPT患者手术中的应用效果及对血钙、血磷、PTH的影响

Effectivenesses of Different Preoperative Parathyroid Positioning Methods in Application of Patients with SHPT after Maintenance Hemodialysis and Their Effects on Blood Calcium,Blood Phosphorus and PTH

目的探讨不同术前甲状旁腺定位方法在维持性血液透析继发性甲状旁腺功能亢进症(SHPT)患者手术中的应用效果及对血钙、血磷、甲状旁腺激素(PTH)的影响。方法选取2019年1月—2020年12月我院99例维持性血液透析SHPT患者,根据术前定位方法的不同分为超声辅助组45和超声组44例。2组均行甲状旁腺切除术,超声组行术前超声定位,超声辅助组行术前超声辅加绘图检查定位。统计2组临床疗效、手术时间、甲状旁腺识别情况,手术前后血钙、血磷、钙磷积、PTH、PTH达标率,以及术后并发症情况。结果2组治疗总有效率比较差异无统计学意义(P>0.05)。超声辅助组手术时间短于超声组,甲状旁腺肉眼识别、定位识别数大于超声组(P<0.05)。术后1个月2组血钙水平、PTH达标率高于术前,血磷、钙磷积、PTH水平低于术前(P<0.05)。术后1个月2组血钙、血磷、钙磷积、PTH水平及PTH达标率比较差异无统计学意义(P>0.05)。2组并发症总发生率比较差异无统计学意义(P>0.05)。结论维持性血液透析SHPT患者手术定位应用超声辅加绘图检查在缩短手术时间、提高甲状旁腺识别率方面具有明显优势。

Objective To investigate effectivenesses of different preoperative parathyroid localization methods in application of patients with secondary hyperparathyroidism(SHPT)after maintenance hemodialysis and its effects on blood calcium,blood phosphorus and parathyroid hormone(PTH).Methods A total of 99 patients undergoing maintenance hemodialysis SHPT between January 2019 and December 2020 were selected and divided into ultrasound assisted group(n=45)and ultrasound group(n=44)according to different preoperative positioning methods.Both groups underwent parathyroidectomy.The ultrasound group underwent preoperative ultrasound localization,while ultrasound assisted group underwent preoperative ultrasound assisted mapping localization.Clinical efficacy,operative duration,condition of parathyroid recognition,as well as blood calcium,blood phosphorus,calcium phosphorus accumulation,PTH,PTH standard rate before and after operation and postoperative complications were analyzed in two groups.Results There was no significant difference in the total effective rate between two groups(P>0.05).In ultrasound assisted group,operative duration was significantly shorter,while numbers of visual recognition and location recognition of parathyroid gland were greater than those in ultrasound group(P<0.05).After operation for one month,levels of blood calcium and PTH standard rates were significantly higher,while levels of blood phosphorus,calcium phosphorus accumulation and PTH were significantly lower than those before operation in two groups(P<0.05).There were no significant differences in levels of blood calcium,blood phosphorus,calcium phosphorus accumulation,PTH and PTH compliance rate after operation for one month between two groups(P>0.05).There was no significant difference in the total incidence rate of complications between two groups(P>0.05).Conclusion Localization by ultrasound assisted drawing examination in application of SHPT after maintenance hemodialysis has obvious advantages in shortening operative duration and improving recognition rate of parathyroid gland.