甲状旁腺全切加前臂自体移植术治疗继发性甲状旁腺功能亢进

doi:10.16260/j.cnki.1009-2188.2017.01.001

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摘要目的探讨甲状旁腺全切加前臂自体移植术对于继发性甲状旁腺功能亢进的治疗效果。方法回顾性分析2015年6月至2016年6月16例行甲状旁腺全切加前臂自体移植术的继发性甲状旁腺功能亢进患者相关临床资料，包括术前、切除后、术后1 d、术后1周及术后4周的甲状旁腺激素、血清钙磷指标、疼痛评分，以及患者术前影像学检查资料和术后病检结果，分析以上指标在各时间节点的变化。结果甲状旁腺全切及自体移植完成率81.25%（13/16），有3例患者术中只找到3个甲状旁腺，因此未做前臂自体移植。患者腺体切除后、术后1 d、术后1周及术后4周的免疫反应性甲状旁腺激素（immunoreactive parathyroid hormone， iPTH)、血清钙、磷浓度及疼痛评分均有明显下降(P<0.05或P<0.01)。术后7 d患者疼痛症状改善显著有效81.25%，基本有效12.5%，无效6.25%。结论甲状旁腺全切加前臂自体移植术是继发性甲状旁腺功能亢进的有效治疗方法，手术风险较低，术后症状及各项生化指标改善显著。

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关键词: 继发性甲状旁腺功能亢进症甲状旁腺全切术甲状旁腺自体移植甲状旁腺激素

Abstract: ObjectiveTo evaluate the clinical efficacy of total parathyroidectomy and parathyroid autotransplatation in the treatment of secondary hyperparathyroidism.MethodsClinical material of 16 cases of secondary hyperparathyroidism were collected and total parathyroidectomy and parathyroid autotransplatation orearm autotransplantation were performed. The serum level of iPTH, calcium, phosphorus and the numeric pain intensity scale(NPIS) were evaluated before surgery, after glands removal, 1 day, 7 days and 4 weeks after surgery. The imaging examination before surgery and pathological examination after surgery were also collected.ResultsThe total parathyroidectomy and parathyroid autotransplatation were completed in 13 cases (81.25%). There was significant decrease of the serum level of iPTH, calcium, phosphorus and NPIS (P<0.05 or P<0.01). The improvement of symptoms were remarkable effective(81.3%), effective(12.5%) and ineffective(6.25%) respectively.ConclusionThe total parathyroidectomy and parathyroid autotransplatation is an effective operation for the treatment of secondary hyperparathyroidism with low risk. The symptoms and biochemical parameters can be improved significantly.

Key words: secondary hyperparathyroidism total parathyroidectomy parathyroid autotransplatation parathyroid hormone

收稿日期: 2016-10-16 修回日期: 2017-01-09 出版日期: 2017-02-26 发布日期: 2018-05-25 期的出版日期: 2017-02-26

ZTFLH:

R653

作者简介: 李可，男， 37岁，长沙市第一医院普外科副主任医师。

引用本文:

李可，周宇帆，胡宪明. 甲状旁腺全切加前臂自体移植术治疗继发性甲状旁腺功能亢进[J]. 中国现代手术学杂志, 2017, 21(1): 1-4.
LI Ke, ZHOU Yufan, HU Xianming. Clinical Effec of Total Parathyroidectomy and Parathyroid Autotransplatation in the Treatment of Secondary Hyperparathyroidism. Chinese Journal of Modern Operative Surgery, 2017, 21(1): 1-4.

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