超声引导下热消融治疗尿毒症继发性甲状旁腺功能亢进症的临床效果

Clinical Effect of Ultrasound-guided Thermal Ablation in the Treatment of Uremic Secondary Hyperparathyroidism

目的观察超声引导下热消融治疗尿毒症继发性甲状旁腺功能亢进症的效果。方法选取2017年1月-2021年3月广西医科大学第一附属医院及玉林市第一人民医院21例确诊为尿毒症继发性甲状旁腺功能亢进症患者作为研究对象,均实施超声引导下热消融术治疗,比较消融术前及术后甲状旁腺激素(iPTH)、血钙、血磷、碱性磷酸酶(ALP)水平,并分析术后并发症发生情况及超声造影术前、术后特点。结果21例患者中有2例实施了射频消融,另外19例实施了微波消融;患者术后第1、7天及第1、3个月的iPTH、血钙、血磷水平均低于术前,差异有统计学意义(P<0.05);术后第1天及第1、3个月ALP低于术前,差异有统计学意义(P<0.05);术后第7天ALP与术前比较,差异无统计学意义(P>0.05);21例患者术后均出现不同程度低钙血症;消融术前甲状旁腺结节超声造影呈强回声,消融区域术后甲状旁腺超声造影显示无增强。结论超声引导下热消融治疗尿毒症继发性甲状旁腺功能亢进症效果确切,可有效降低iPTH、血钙、血磷水平。

Objective To observe the effect of ultrasound-guided thermal ablation in the treatment of uremic secondary hyperparathyroidism.Methods Twenty-one uremia patients with secondary hyperparathyroidism diagnosed as in the First Affiliated Hospital of Guangxi Medical University and the Yulin First People's Hospital from January 2017 to March 2021 were selected as subjects.All patients were treated with ultrasound-guided thermal ablation.The levels of iPTH,blood calcium,blood phosphorus and alkaline phosphatase(ALP)before and after ablation were compared,and the occurrence of postoperative complications and characteristics of ultrasound contrast before and after operation were analyzed.Results Two of the 21 patients underwent radiofrequency ablation,and the other 19 patients underwent microwave ablation.The levels of iPTH,serum calcium and serum phosphorus at 1,7 days and 1,3 months after operation were lower than those before operation,and the differences were statistically significant(P<0.05).The ALP level at 1 day,1 month and 3 months after operation was lower than that before operation,and the difference was statistically significant(P<0.05).There was no significant difference in ALP between before operation and 7 days after operation(P>0.05).21 patients had varying degrees of hypocalcemia.Contrast-enhanced ultrasonography of parathyroid nodules showed strong echo before ablation,and no enhancement was found after ablation.Conclusion Ultrasound-guided thermal ablation is effective in the treatment of uremia secondary hyperparathyroidism,which can effectively reduce the levels of iPTH,serum calcium and serum phosphorus.