γ探测仪引导下甲状旁腺全切除及自体移植治疗继发性甲状旁腺功能亢进的效果

Effect ofγ-detector guided total parathyroidectomy and auto transplantation in treatment of secondary hyperparathyroidism

目的探讨术中γ探测仪在慢性肾脏疾病继发性甲状旁腺功能亢进(secondary hyperparathyroidism,sHPT)患者行甲状旁腺全切除(total parathyroidectomy,tPTX)+自体移植(auto transplantation,AT)中的应用价值。方法回顾性分析2014年7月至2019年6月期间于江苏省苏北人民医院接受tPTX+AT的110例sHPT患者的临床资料,其中80例患者术中在γ探测仪引导下行tPTX+AT(观察组),30例患者在常规探查后行tPTX+AT(对照组)。比较2组患者的手术时间、切除甲状旁腺数目、血全段甲状旁腺激素(intact parathyroid hormone,iPTH)浓度、血钙和血磷水平以及术后并发症发生和复发情况。结果对照组切除的甲状旁腺数目少于观察组[(3.87±0.35)枚/例比(4.01±0.11)枚/例,P<0.05],而手术时间长于观察组[(115±25)min比(75±27)min,P<0.05]。与术前相比,所有患者术后的iPTH、血钙和血磷水平均降低,且所有患者手术后自觉症状均明显好转,瘙痒、骨痛和肌肉无力症状减轻或消退。全组无死亡病例,无吞咽困难、饮水呛咳等喉上神经损伤表现。观察组及对照组术后各有1例患者出现声音嘶哑,对照组1例患者发生颈部切口出血;观察组1例术后短期复发,对照组4例术后短期复发。2组的术后并发症发生率比较差异无统计学意义(χ^(2)=2.413,P>0.05),但对照组的复发率高于观察组(χ^(2)=7.342,P<0.05)。结论术中γ探测仪有助于术中快速识别并切除非典型增生及异位甲状旁腺,能够提高tPTX的准确率及缩短手术时间,减少复发。

Objective To explore the application value of intraoperative gamma detector in patients with chronic kidney disease secondary hyperparathyroidism(sHPT)undergoing total parathyroidectomy(tPTX)+auto transplantation(AT).Methods A retrospective analysis of the clinical data of 110 sHPT patients who received tPTX+AT at Northern Jiangsu Province People’s Hospital from July 2014 to June 2019 was performed.Among them,80 patients underwent tPTX+AT guided by the gamma detector during the operation(observation group),30 patients underwent tPTX+AT under routine exploration(control group).We compared the operation time,number of parathyroid glands removed,serum intact parathyroid hormone(iPTH)concentration,serum calcium and phosphorus levels,as well as the occurrence of postoperative complications and recurrence rate were compared between the two groups.Results The number of parathyroid glands removed of the control group was lower than that of the observation group[(3.87±0.35)per case vs.(4.01±0.11)per case,P<0.05],but the operation time of the control group was longer[(115±25)min vs.(75±27)min,P<0.05].Postoperative iPTH,serum calcium and serum phosphorus levels were significantly reduced in all patients.After the operation,the symptoms of pruritus,bone pain,and muscle weakness were relieved or disappeared.There was no death,dysphagia,drinking water choking cough,and superior laryngeal nerve injury occurred.One patient in the observation group and one patient in the control group had hoarseness,and one patient in the control group had cervical incision bleeding;one patient in the observation group and four patients in the control group suffered short-term postoperative recurrence due to incomplete parathyroidectomy.There was no significant difference in the incidence of complications(χ^(2)=2.413,P>0.05),but the short-term postoperative recurrence rate of the observation group was lower than that of the control group(χ^(2)=7.342,P<0.05).Conclusion Gamma detector is helpful for rapid identification of typical hyperplasia and ectopic parathyroid glands during operation,and can improve the accuracy of tPTX,save operation time,and reduce the recurrence.