注射式自体组织匀浆移植术在继发性甲状旁腺功能亢进症手术治疗中的应用研究

Application of injection autologous tissue homogenate implantation in surgical treatment of secondary hyperparathyroidism

目的探讨注射式自体组织匀浆移植术在继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)手术治疗中的应用价值。方法选取2017年6月至2021年6月于四川绵阳四〇四医院长期规律血液透析且内科治疗无效的SHPT患者46例,根据随机数字表法将患者分为匀浆注射组和颗粒包埋组,每组各23例。匀浆注射组患者采用甲状旁腺切除术(parathyroidectomy,PTX)加自体前臂注射式匀浆移植术,颗粒包埋组患者采用PTX加自体前臂颗粒包埋移植术;比较两组患者手术前后的血钙、血磷、全段甲状旁腺激素(intact parathyroid hormone,iPTH)、碱性磷酸酶(alkaline phosphatase,ALP)变化以及手术后的血管钙化、皮肤瘙痒、骨痛、睡眠障碍等改善情况。结果术后1年,两组患者的血清钙水平显著高于本组治疗前,血清磷、iPTH、ALP水平显著低于本组治疗前(P<0.05)。匀浆注射组患者的血清钙水平显著高于颗粒包埋组,血清磷、iPTH、ALP水平显著低于颗粒包埋组(P<0.05);匀浆注射组患者的血管钙化、皮肤瘙痒、骨痛、睡眠障碍等改善情况均优于颗粒包埋组(P<0.05)。结论注射式自体组织匀浆移植术用于难治性SHPT患者安全有效,移植成功率高,创伤小,可改善患者症状,提高生存质量。

Objective To investigate the application value of injectable autogenous tissue homogenate implantation in surgical treatment of secondary hyperparathyroidism(SHPT).Methods A total of 46 patients with SHPT who underwent long-term regular hemodialysis and failed medical treatment in Sichuan Mianyang 404 Hospital from June 2017 to June 2021 were selected.According to random number table method,the patients were divided into homogenate injection group and particle embedding group,with 23 cases in each group.Parathyroidectomy(PTX)plus autogenous forearm injection homogenate implantation was performed in homogenate injection group,and PTX plus autogenous forearm particle implantation was performed in particle embedding group.The changes in blood calcium,blood phosphorus,intact parathyroid hormone(iPTH),and alkaline phosphatase(ALP)of two groups before and after operation,as well as the improvements in vascular calcification,pruritus,bone pain,and sleep disorders after operation were compared.Results One year after surgery,the serum calcium level of two groups were significantly higher than before treatment,and the serum phosphorus,iPTH and ALP levels were significantly lower than before treatment(P<0.05).The serum calcium level in homogenate injection group was significantly higher than that in particle embedding group,and the serum phosphorus,iPTH and ALP levels were significantly lower than those in particle embedding group(P<0.05).The improvement of blood vessel calcification,pruritus,bone pain and sleep disorder in homogenate injection group were better than those in particle embedding group(P<0.05).Conclusion Injectable autologous tissue homogenate implantation for refractory SHPT patients is safe and effective,with high success rate,less trauma,and can improve patient symptoms and quality of life.