甲状旁腺全切联合自体前臂移植治疗尿毒症后继发性甲状旁腺功能亢进的近期疗效观察

Short-term outcome of total parathyroidectomy plus autologous forearm transplantation for treatment of hyperparathyroidism secondary to uremia

目的:观察甲状旁腺全切联合自体前臂移植治疗尿毒症后继发性甲状旁腺功能亢进(SHPT)的近期疗效。方法:选取广东省惠州市中心人民医院收治的尿毒症后SHPT患者60例,按随机数字表法分为对照组(30例)和研究组(30例)。对照组采用甲状旁腺全切术治疗,研究组采用甲状旁腺全切联合自体前臂移植治疗。对比两组甲状旁腺激素(PTH)、血钙(Ca2+)、血磷(P3+)、血红蛋白(Hb)、血细胞比容(Hct)、并发症发生率、心脏结构与功能指标[舒张末期室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室射血分数(EF)、舒张末期左心室内径(LVED)]水平。结果:术后3个月,两组PTH、Ca2+、P3+水平均低于术前(P<0.05),但两组之间比较,差异无统计学意义(P>0.05);两组Hb、Hct水平均高于术前,其中研究组高于对照组(P<0.05);两组IVST、LVPWT、EF、LVED水平均优于术前,其中研究组EF水平高于对照组,IVST、LVPWT、LVED水平低于对照组(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:甲状旁腺全切联合自体前臂移植治疗尿毒症后SHPT疗效确切,安全性高,改善患者心脏结构及功能方面优势显著,且能进一步改善患者Hb、Hct水平,有助于降低贫血发生率,改善预后。

Objective:To investigate the short-term outcome of total parathyroidectomy plus autologous forearm transplantation for the treatment of secondary hyperparathyroidism(SHPT)following uremia.Methods:Sixty patients with SHPT following uremia admitted to Huizhou Central People’s Hospital,Guangdong Province,were divided into the control group(n=30)and study group(n=30)using random number table method.The control group was treated with total parathyroidectomy alone,and study group with total parathyroidectomy plus autologous forearm transplantation.The two groups were compared for serum levels of parathyroid hormone(PTH),calcium(Ca2+)and phosphorus(P3+),blood hemoglobin(Hb),hematocrit(Hct),occurrence of complications,heart structural and functional indicators(end-diastolic interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),left ventricular ejection fraction(EF),and left ventricular end-diastolic diameter(LVED))Results:At 3 mo after surgery,the PTH,Ca2+,and P3+levels in the both groups were lower compared with baseline(P<0.05),but were not significantly different between groups(P>0.05);the Hb and Hct levels were higher in the two groups compared with baseline,and also in the study group compared with the control group(P<0.05);the values of IVST,LVPWT,EF and LVED were improved in either group compared with baseline.Among these,the study group showed higher EF value,and lower IVST,LVPWT and LVED values,compared with the control group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:Total parathyroidectomy plus autologous forearm transplantation for treatment of SHPT following uremia appears effective and safe,with significant advantages in improving the heart structure and functions.This surgical option also offers benefits in increasing Hb and Hct levels,thereby may help reduction on incidence of anemia and lead to better outcomes.