超声引导下微波消融序贯甲状旁腺切除术治疗原发性甲状旁腺功能亢进症伴高钙危象的疗效研究

Efficacy of ultrasound-guided microwave ablation sequential parathyroidectomy in treating primary hyperparathyroidism with hypercalcemic crisis

目的 探讨超声引导下微波消融序贯甲状旁腺切除术治疗原发性甲状旁腺功能亢进症(PHPT)伴高钙危象的疗效。方法 选取我院内科有急诊手术禁忌证的PHPT伴高钙危象患者11例,患者在诊断为高钙危象且急诊内科治疗48 h无效后,急诊行甲状旁腺超声引导下微波消融治疗,待临床症状消失、血钙降至正常范围后再行甲状旁腺切除术。比较超声引导下微波消融序贯甲状旁腺切除术前后全段甲状旁腺激素(iPTH)及血钙、磷水平,总结行甲状旁腺切除术的合适手术时间;并观察其序贯治疗疗效。结果 超声引导下微波消融后6 h、1~3 d血清iPTH、血钙均较消融前显著降低(均P<0.01),其中消融治疗后1~3 d血钙逐渐降低至安全范围,血磷逐渐升高,是较为合适的甲状腺切除术时机。甲状旁腺切除术后3 d所有患者血钙均恢复至正常,与术前比较差异有统计学意义(P<0.01),其中5例患者在术后2 d内发生低钙血症,给予口服补钙或静脉补钙后恢复正常;所有患者在甲状旁腺切除术后7 d内骨痛、关节疼痛、气促、乏力及恶心呕吐等胃肠道症状均改善明显,心率较术前显著下降[(92±9)次/min vs.(110±10)次/min,P<0.01],情绪低沉等精神状况显著好转。结论 超声引导下微波消融序贯甲状旁腺切除术是治疗PHPT伴高钙危象的一种安全、有效的方式。

Objective To explore the efficacy of ultrasound-guided microwave ablation sequential parathyroidectomy in treating primary hyperparathyroidism(PHPT)with hypercalcemic crisis.Methods Eleven PHPT patients with hypercalcemic crisis who did not respond to medical treatment and had contraindications to emergency surgery in our hospital were enrolled.After diagnosis of hypercalcitonin crisis and 48 h of ineffective internal medicine treatment,emergency parathyroid ultrasound-guided microwave ablation was performed.Once clinical symptoms subsided and serum calcium levels returned to normal,parathyroidectomy was performed.The levels of intact parathyroid hormone(iPTH),blood calcium and phosphorus before and after ultrasound-guided microwave ablation sequential parathyroidectomy were compared,and the appropriate time for parathyroidectomy was summarized.The sequential therapeutic effect was observed.Results The serum iPTH and blood calcium were significantly decreased at 6 h and 1~3 d after ultrasound-guided microwave ablation compared with those before ablation(all P<0.01),and the blood calcium gradually decreased to the safe range and blood phosphorus gradually increased at 1~3 d after ablation,which was a appropriate time for parathyroidectomy.The blood calcium in all patients recovered to normal level at 3 d after parathyroidectomy,and the difference was statistically significant compared with that before parathyroidectomy(P<0.01).Among them,5 patients developed hypocalcemia within 2 d after parathyroidectomy,but returned to normal after supplementing with oral calcium and intravenous calcium.All patients showed significant improvement in gastrointestinal symptoms such as bone pain,joint pain,shortness of breath,fatigue,and nausea and vomiting within 7 d after parathyroidectomy.The heart rate decreased significantly compared with that before parathyroidectomy[(92±9)beats/min vs.(110±10)beats/min,P<0.01],and the emotional and low mood mental states improved significantly.Conclusion Ultrasound-guided microwave ablation sequential parathyroidectomy is a safe and effective treatment approach for PHPT with hypercalcemic crisis.