继发性甲状旁腺功能亢进术后复发或持续状态再次手术策略

Analysis and strategy of reoperation for recurrent/persistent secondary hyperparathyroidism

继发性甲状旁腺功能亢进(SHPT)是终末期肾脏病病人的常见并发症,当发展为药物难治性SHPT时,手术是缓解症状、改善预后的有效治疗方法。由于不恰当的术式选择、异位甲状旁腺、移植物复发等原因,初次手术存在失败可能,临床上表现为复发性甲状旁腺功能亢进(RHPT)和持续性甲状旁腺功能亢进(PHPT)。再次手术是RHPT或PHPT的最佳治疗策略,术前联合应用多种影像学检查定位甲状旁腺及术中应用洗脱液甲状旁腺素(PTH)测定和纳米碳负显影法等可以提高手术效率。

Secondary hyperparathyroidism(SHPT)is a common complication of patients with end-stage renal disease.When patients develop drug-resistant SHPT,surgery is an effective treatment to relieve symptoms and improve prognosis.Due to inappropriate surgical choice,ectopic parathyroid gland,graft recurrence and other reasons,the initial operation may fail,which clinically manifests as recurrent hyperparathyroidism(RHPT)and persistent hyperparathyroidism(PHPT).Reoperation is the best treatment strategy for RHPTor PHPT.Preoperative combined application of multiple imaging examinations to locate the parathyroid gland and intraoperative application of eluent parathyroid hormone(PTH)determination and negative carbon nano imaging can improve the efficiency of surgery.