精准腺体移植量对继发性甲状旁腺功能亢进患者外科治疗的临床效果分析

Clinical effect of precision gland transplantation on surgical treatment of secondary hyperparathyroidism

目的:探讨甲状旁腺全切加前臂移植术中精准腺体移植量治疗继发性甲状旁腺功能亢进患者的临床效果。方法:选取2018年10月—2021年8月期间南通市第三人民医院收治的慢性肾功能衰竭后继发性甲状旁腺功能亢进行甲状旁腺全切加前臂移植术的患者40例,按随机数字表法分为观察组和对照组,各20例。对照组腺体移植量为1 mg/kg体质量;观察组腺体移植量为0.5 mg/kg体质量。观察两组患者术前及术后1 d、5 d、1个月、3个月、6个月、1年的甲状旁腺激素(parathyroid hormone,PTH)、血钙、血磷的变化,及骨痛、皮肤瘙痒的缓解情况。结果:两组患者手术成功率为97.50%。两组患者术后6个月内的PTH、血钙、血磷均较术前有所下降,观察组术后3个月、6个月、1年的PTH均低于对照组(均P<0.05),且观察组PTH上升曲线幅度较对照组减缓。两组患者术后骨痛症状均明显缓解,皮肤瘙痒症状缓解率差异无统计学意义(P>0.05)。结论:甲状旁腺全切加前臂移植术能有效治疗继发性甲状旁腺功能亢进,且指南推荐的范围内较少的精准腺体移植量(0.5 mg/kg体质量)能在短期内有效减缓PTH的上升。

Objective:To study the clinical efficacy of total parathyroidectomy plus forearm transplantation in the treatment of patients with secondary hyperparathyroidism by precise gland transplantation.Methods:Forty patients with secondary hyperparathyroidism after chronic renal failure who underwent total parathyroidectomy plus forearm transplantation in Nantong Third People′s Hospital from October 2018 to August 2021 were selected and divided into observation group and control group,20 cases in each group according to random number table method.The amount of gland transplantation in the control group was 1 mg/kg body weight.The amount of gland transplantation in the observation group was 0.5 mg/kg body weight.The results of parathyroid hormone(PTH),blood calcium and blood phosphorus,as well as the relief of bone pain and skin pruritus in 2 groups were observed before surgery,1 day,5 days,1 month,3 months,6 months and 1 year after surgery.Results:The success rate of operation in the two groups was 97.50%.PTH,blood calcium and blood phosphorus in both groups decreased at 6 months after surgery compared with that before surgery.PTH in the observation group was lower than that in the control group on the 3 months,6 months and 1 year after surgery(P<0.05),and PTH ascending curve in the observation group moved right compared with that in the control group.The symptoms of bone pain were significantly relieved in 2 groups,and there was no significant difference in the relieving rate of postoperative pruritus between 2 groups(P>0.05).Conclusions:Total parathyroidectomy plus forearm transplantation is effective in the treatment of secondary hyperparathyroidism,and within the guideline recommended range,a small amount of precise gland transplantation(0.5 mg/kg body weight)can effectively alleviate the rise of PTH in the short term.