穿刺上腹部皮下组织内甲状旁腺移植治疗继发性甲状旁腺功能亢进的临床分析

Clinical analysis of puncturing epigastrium subcutaneous tissue transplantation of parathyroid gland in treatment of secondary hyperparathyroidism

目的评估穿刺上腹部皮下组织内甲状旁腺移植治疗继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的临床效果。方法回顾性收集2020年1月至2022年6月期间于徐州市中心医院普外科行穿刺上腹部皮下组织内甲状旁腺移植治疗的SHPT患者的临床资料,分析患者术前(指术前1 d)及术后第1天时的甲状旁腺激素水平、钙离子浓度、碱性磷酸酶水平、磷离子浓度的变化及术后随访结果。数据分析采用SPSS 23.0软件,检验水准α=0.01。结果共收集到21例行甲状旁腺全切除联合穿刺上腹部皮下组织内甲状旁腺移植患者,其中女9例、男12例;年龄32~71岁、中位年龄48岁;透析时间(8.62±2.27)年;合并高血压12例、贫血9例、骨痛17例、皮肤瘙痒11例。所有患者术后第1天时的血清甲状旁腺激素水平、钙离子浓度和磷离子浓度均较术前明显降低[分别为:(5.99±3.50)ng/L比(1893.23±539.30)ng/L,P<0.001;(2.24±0.35)mmol/L比(2.52±0.31)mmol/L,P=0.003;(1.76±0.38)mmol/L比(2.25±0.71)mmol/L,P=0.006],碱性磷酸酶水平尽管下降但差异无统计学意义[(229.32±89.32)U/L比(321.78±151.01)U/L,P=0.016]。术前12例伴有高血压的患者术后有6例好转且减少了降压药的使用,9例伴贫血患者有3例在出院前改善,17例伴骨痛患者出院前明显缓解,11例伴有皮肤瘙痒患者有9例在出院前缓解。术后无声音嘶哑、饮水呛咳、切口感染等并发症发生。21例患者均获得随访,随访时间6~12个月,21例患者的甲状旁腺激素水平在术后12个月内均降至正常水平,其中术后第3个月时有3例、术后第6个月时有16例、术后第12个月时有2例恢复至正常水平,恢复至正常水平时间为(5.86±2.70)个月。随访过程中患者生存状态良好,随访期间无患者死亡,无术后并发症发生,无复发。结论从本组病例分析结果看,对SHPT患者采用穿刺上腹部皮下组织内甲状旁腺自体移植安全及有效。

Objective To assess the clinical efficacy of percutaneous transplantation of parathyroid glands into the subcutaneous tissue of the epigastrium for treating malignant secondary hyperparathyroidism(SHPT).Methods The clinical data of the patients with SHPT who were treated by puncturing the subcutaneous tissue of the epigastrium and transplanting parathyroid glands in the Xuzhou Central Hospital from January 2020 to June 2022 were collected retrospectively.The preoperative and postoperative parathyroid hormone(PTH)level,calcium ion concentration,alkaline phosphatase(ALP)level,and phosphorus ion concentration,as well as postoperative follow-up results were analyzed.The data analysis was conducted using SPSS 23.0 software,with a testing level of 0.01.Results A total of 21 patients successfully underwent this surgery,including 12 males and 9 females,with a median age of 48 years old and a range of 32–71 years old.The dialysis time was(8.62±2.27)years,and 12 patients had hypertension,9 patients had anemia,17 patients had bone pain,and 11 patients had skin itching.On day 1 after treatment,the PTH level decreased from(1893.23±539.30)ng/L to(5.99±3.50)ng/L(P<0.001),the calcium ion concentration decreased from(2.52±0.31)mmol/L to(2.24±0.35)mmol/L(P=0.003),and the phosphorus ion concentration decreased from(2.25±0.71)mmol/L to(1.76±0.38)mmol/L(P=0.006)as compared with the values before surgery.Although the ALP level decreased from(321.78±151.01)U/L to(229.32±89.32)U/L,there was no statistically significant difference(P=0.016).Among the 12 patients with hypertension before surgery,6 patients improved and reduced the use of antihypertensive drugs after surgery;among the 9 patients with anemia,3 patients improved before discharge;17 patients with bone pain showed markedly relief before discharge;and 9 patients with skin itching improved before discharge.There were no complications such as hoarseness,choking cough when drinking water,or incision infection after the operation.All 21 patients were followed up for 6–12 months.The parathyroid hormone levels of the 21 patients all dropped to the normal level within 12 months after the operation.Among them,3 patients recovered to the normal level at the 3rd month after the operation,16 patients recovered to the normal level at the 6th month after the operation,and 2 patients recovered to the normal level at the 12th month after the operation.The time to return to the normal level was(5.86±2.70)months.No serious complications occurred in all patients,and there was no recurrent case during follow-up period.Conclusion From the analysis results of our study,parathyroid autotransplantation into the subcutaneous tissue of the epigastrium via puncture is a safe and effective method for patients with SHPT.