全甲状旁腺切除术加前臂移植术治疗继发性甲旁亢的手术体会

Total Parathyroidectomy with Forearm Autograft in the Treatment of Secondary Hyperparathyroidism Surgery

目的探讨继发性甲状腺旁功能亢进采取全甲状旁腺切除术加前臂移植术治疗的临床效果。方法选取我院2014年6月至2016年6月收治的继发性甲状腺旁功能亢进患者5例作为本次研究对象,入选患者均进行全甲状旁腺切除术,并配合前臂移植术治疗,观察对比患者手术前后碱性磷酸酶(ALP)、血钙(Ca^(2+))、血磷(P^(3+))等指标变化,并记录手术前后甲状旁腺激素iPTH值。结果患者均顺利完成手术,其中有3例患者发现甲状旁腺4枚,有2例患者发现甲状旁腺3枚,均经病理检查确诊为弥漫性增生,术后皮肤瘙痒、骨痛、低血钙等临床症状均得到改善;患者术后6个月、12个月ATP水平较术前有明显改善,患者术后1周、1个月、6个月、12个月的Ca^(2+)、P^(3+)、iPTH水平较术前有明显改善,差异有统计学意义(P<0.05);术后随访5至48个月,有1例继发性甲状旁腺功能亢进症复发,经种植切除后病情好转。结论对继发性甲状腺旁功能亢进疾病的治疗,采取全甲状旁腺切除术和前臂移植术联合治疗的临床效果较好,可改善患者的临床症状,且安全可靠,可作为本病的理想术式。

Objective To investigate the clinical effect of total thyroidectomy plus forearm transplantation in the treatment of secondary hyperthyroidism. Methods In our hospital from June 2014 to June 2016 were secondary thyroid function in patients with hyperthyroidism in 5 cases as the research object, all patients underwent total parathyroidectomy with forearm autograft, and treatment, observation of patients before and after surgery compared with alkaline phosphatase(ALP), serum calcium(Ca^(2+)), phosphorus(P^(3+)) and other indicators of change. And record the parathyroid hormone iPTH value before and after surgery. Results The patients were successfully completed surgery, including 3 cases of parathyroid found 4, 2 cases of parathyroid 3, were pathologically diagnosed as diffuse hyperplasia, postoperative skin itching, pain, hypocalcemia and other clinical symptoms were improved; Patients after 6 months and 12 months ATP level is preoperative patients significantly improved after 1 weeks, 1 months, 6 months, 12 months of Ca^(2+), P^(3+) and i PTH levels were significantly improved after operation, the difference was statistically significant(P<0.05); Patients were followed up for 5 to 48 months, there were 1 cases of secondary hyperparathyroidism complex after planting, the condition improved after resection. Conclusion The secondary parathyroid hyperfunction of disease treatment. Take the clinical effect of total parathyroidectomy with forearm autograft combined treatment, can improve clinical symptoms of patients, and is safe and reliable, can be used as the ideal method of this disease.