甲状旁腺全切联合自体前臂移植术治疗终末期肾病继发性甲状旁腺功能亢进症的临床分析

Clinical analysis of parathyroidectomy combined with autotransplantation in 33 cases of secondary hyperparathyroidism to end-stage renal disease

摘要:

目的 分析甲状旁腺全切联合自体前臂移植术对终末期肾病继发性甲状旁腺功能亢进症（SHPT）的疗效。方法 选取2015年5月—2019年6月在湖南省人民医院乳甲外科接受甲状旁腺全切联合前臂自体移植术的33例终末期肾病合并SHPT的患者，分析其预后、并发症、甲状旁腺激素（PTH）和电解质的变化。结果 所有患者手术成功，共取得甲状旁腺结节130枚，其中甲状旁腺腺瘤结节40枚，甲状旁腺组织增生结节82枚，余8枚为腺瘤与增生组织混合结节。甲状旁腺全切5 min、20 min后PTH值均较术前下降80%以上，33例患者的骨痛和其中20例患者合并存在的皮肤瘙痒症状在术后1个月内缓解，9例患者的骨折或畸形情况在术后6个月得到了不同程度的缓解，患者PTH、钙磷水平和钙磷乘积较术前明显下降，29例患者出现术后低钙血症，经1～14 d对症治疗后血钙值恢复正常。结论 甲状旁腺全切联合自体前臂移植术能有效改善终末期肾病SHPT的症状。

Abstract:

Objective To analyze the effect of total parathyroidectomy combined with autotransplantation on secondary hyperparathyroidism to renal insufficiency.Methods From May 2015 to June 2019, the prognosis, complications, changes of IPH, and electrolytes of 33 patients with chronic renal insufficiency and SHPT who received total parathyroidectomy (t-ptx) and autotransplantation in our hospital were observed.Results There were 130 parathyroid nodules, including 40 parathyroid adenomas, 82 parathyroid tissues, and 8 mixed nodules of adenomas and tissues. The PTH value decreased by 80% or more after 5 and 20 minutes of total parathyroidectomy. The bone pain of 33 patients and itching of 20 patients were relieved within 1 month after operation, and the fracture or deformity of 9 patients were relieved to some extent in 6 months after operation. The level of PTH, calcium, phosphorus and the result of calcium phosphorus multiplication were significantly lower than those before operation. Hypocalcemia occurred in 29 patients at different time after operation. The blood calcium returned to normal level after 1-14 days of intravenous and oral calcium supplementation.Conclusion Parathyroidectomy combined with autotransplantation can effectively treat the secondary hyperparathyroidism of renal insufficiency.