| 摘要: |
| ［摘要］ 目的 比较甲状旁腺全切除术（TPTX）和甲状旁腺全切除加自体移植术（TPTX+AT）治疗尿毒症后继发性甲状旁腺功能亢进（SHPT）的临床疗效。方法 回顾性分析2014-06～2017-06三家医院行甲状旁腺切除手术的200例尿毒症后SHPT患者的临床资料，其中行TPTX 97例（TPTX组），行TPTX+AT 103例（TPTX+AT组），收集两组术前、术后1 d、1周、3个月、1年血清全段甲状旁腺激素(iPTH)、血钙、血磷值，观察临床症状及术后并发症、复发情况等资料。结果 所有患者顺利完成手术治疗，术后骨痛、皮肤瘙痒、肌无力和不安腿等症状明显缓解，两组术后1 d、1周、3个月、1年的iPTH、血钙及血磷值均较术前明显下降（P<0.05），但两组各时点间iPTH、血钙、血磷值比较差异无统计学意义(P>0.05)；两组术后iPTH、血钙、血磷值下降幅度差异无统计学意义(P>0.05)。随访1年两组的复发率，TPTX组为3.09%（3/97），低于TPTX+AT组的3.88%（4/103），但差异无统计学意义（P>0.05）。两组患者均未出现严重的无法耐受的低钙血症或低转运性骨病等明显的不良反应。结论 两种术式均能有效治疗尿毒症后SHPT，不良反应发生率和复发率均较低。应遵循个体化原则、患者要求及有无肾移植意愿决定手术方式。 |
| 关键词: 继发性甲状旁腺功能亢进 甲状旁腺全切除术 甲状旁腺全切除加自体移植术 |
| DOI：10.3969/j.issn.1674-3806.2019.03.04 |
| 分类号: |
| 基金项目:广西科学研究与技术开发计划项目（编号：桂科攻1598012-15）；广西医疗卫生适宜技术开发与推广应用项目（编号：S2017083） |
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| Comparison of the effects of total parathyroidectomy and total parathyroidectomy with auto-transplantation on hyperparathyroidism secondary to uremia |
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LIAO Dan, LIU Tian-qi, ZHU Mao-guang
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Department of Thyroid and Breast Surgery, the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning 530023, China
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| Abstract: |
| ［Abstract］ Objective To compare the clinical efficacy of total parathyroidectomy(TPTX) and total parathyroidectomy with auto-transplantation (TPTX+AT) on uremic secondary hyperparathyroidism(SHPT). Methods A retrospective analysis was performed on 200 uremic SHPT patients from three hospitals who underwent parathyroidectomy during June 2014 and June 2017. The TPTX group(n=97) underwent TPTX and the TPTX+AT group(n=103) underwent TPTX+AT. Intact parathyroid hormone(iPTH), calcium and phosphorus in serum were collected before operation and at the first day, first week, third month and the first year after operation. Clinical symptoms, postoperative complications and palindromia were observed. Results All the patients were operated smoothly, and their symptoms such as bone pain, skin itching, myasthenia and restless leg syndrome were significantly alleviated after operation. The levels of iPTH, calcium and phosphorus in the two groups decreased significantly at the first day, first week, third month and the first year after operation compared with those before operation(P<0.05). The differences of iPTH, serumal calcium and phosphorus levels were not statistically significant between the two groups at different time points after operation(P>0.05). There were no significant differences in the decreased levels of iPTH, serumal calcium and phosphorus between the two groups after operation(P>0.05). During a follow-up of 1 year, the recurrence rate of the TPTX group［ 3.09%(3/97)］ was lower than that of the TPTX+AT group［3.88%(4/103)］, but the difference was not statistically significant(P>0.05). There were no obvious adverse reactions in both groups, such as severe intolerable hypocalcemia, low transport osteopathy and so on. Conclusion Both of the operative methods are effective in treatment of uremic SHPT. The adverse reactions and recurrence rates are low. The selection of the operative methods should follow the principle of individualization, patients′ requirements and the willingness of kidney transplantation. |
| Key words: Secondary hyperparathyroidism Total parathyroidectomy Total parathyroidectomy with auto-transplantation |
