甲状旁腺全切除术在慢性肾功能衰竭继发性甲状旁腺功能亢进症治疗中的应用

Total parathyroidectomy in the treatment of chronic renal failure complicating secondary hyperparathyroidism

目的探讨术前甲状旁腺定位的影像学检查的选择, 明确甲状旁腺全切除术治疗慢性肾功能衰竭继发性甲状旁腺功能亢进症的安全性。方法回顾性分析2012年3月至2022年3月于大连大学附属中山医院普通外科行甲状旁腺全切除术治疗继发性甲状旁腺功能亢进症的257例患者的临床资料。结果在术中病理证实切除4枚甲状旁腺且术前同时行超声和增强CT检查的246例患者中术前彩超共检测出640枚甲状旁腺, 其中4枚甲状旁腺同时定位准确的患者54例;术前增强CT共检测出954枚甲状旁腺, 4枚同时定位准确的患者216例。增强CT的甲状旁腺检出率与彩超比较差异有统计学意义(χ^(2)=325.480, P<0.001), 准确率与彩超比较差异有统计学意义(χ^(2)=215.146, P<0.001)。术前、术后当天、术后第1天、第7天全段血清甲状旁腺激素平均值分别为(1 880±890)、(137±82)、(66±46)、(34±23)pg/ml。全部患者的临床症状均得到明显缓解。结论增强CT在甲状旁腺术前定位的整体检出率和个体定位准确率上均优于彩超, 甲状旁腺全切除术治疗继发性甲状旁腺功能亢进症是安全可靠的。

Objective To comparae the accuracy of imaging examination in preoperative parathyroid localization,and the safety and effect of total parathyroidectomy on secondary hyperparathyroidism complicated by chronic renal failure.Method A total of 257 patients with secondary hyperparathyroidism who underwent total parathyroidectomy at the Department of General Surgery,Zhongshan Hospital,Dalian University from Mar 2012 to Mar 2022 were analyzed retrospectively.Result Six hundred fourty parathyroid glands were found by color Doppler ultrasound and 954 parathyroid glands were by enhanced CT before the operation.Among them,the number of patients with accurate location of all 4 parathyroid glands by color Doppler ultrasound was 54,while that by enhanced CT was 216.The parathyroid detection rate by enhanced CT was significantly higher than that of color Doppler ultrasound(χ2=325.480,P<0.001),and the accuracy rate was significantly higher tnan that of color ultrasound(χ2=215.146,P<0.001).The average values of iPTH before operation,on the day after operation,on the 1st day and 7th day after operation were(1880±890),(137±82),(66±46)and(34±23)pg/ml,respectively.The clinical symptoms of all patients were significantly relieved.Conclusions Enhanced CT is superior to color Doppler ultrasound in the overall detection rate and individual localization accuracy of preoperative parathyroid localization.Total parathyroidectomy is safe and reliable in the treatment of secondary hyperparathyroidism complicated by chronic renal failure.