继发性甲状旁腺功能亢进不同手术方式的疗效分析
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摘要
目的分析比较甲状旁腺次全切除术和甲状旁腺全切+前臂自体移植术对于治疗尿毒症继发性甲状旁腺功能亢进的临床疗效。方法回顾性分析2012年1月～2018年6月在大连市友谊医院行手术治疗的继发性甲状旁腺功能亢进患者资料31例。病例分为2组,Ⅰ组行甲状旁腺次全切除术(20例),Ⅱ组行甲状旁腺全切+前臂自体移植术(11例)。对患者术前,术后1周、1、3、6个月血钙、血磷、血PTH水平、临床症状改善程度等资料进行分析。结果术后血钙、血磷、血i PTH均较术前明显下降,差异有统计学意义(P<0.05)。两组间术前、术后血钙、血磷及术后6个月血iPTH的水平差异不大,无统计学意义(P>0.05)。两组患者术后骨痛、皮肤瘙痒、不安腿综合征均得到明显改善,两组间症状减轻程度差异无统计学意义(P>0.05)。结论两种术式均能有效治疗尿毒症继发性甲状旁腺功能亢进,手术安全性高,两组对血钙、血磷的影响无明显差异,全切+前臂自体移植组短期内甲状旁腺激素下降更加明显。二者均存在复发的可能性,全切+前臂自体移植术二次手术简便易行,具有一定的优势。
OBJECTIVE To analyze and compare the clinical efficacy of subtotal-parathyroidectomy and totalparathyroidectomy with forearm autotransplantation in the treatment of hyperparathyroidism secondary to uremia.METHODS The clinical data of 31 cases of secondary hyperparathyroidism(SHPT) who were operated in Dalian Friendship Hospital from January 2012 to June 2018 were retrospectively analyzed. The cases were divided into two groups. Subtotal parathyroidectomy was performed in group one(20 cases) and total parathyroidectomy with forearm autotransplantation were performed in group two(11 cases). Preoperative, postoperative one week,1 month, 3 months, 6 months of patients with the levels of blood calcium, blood phosphorus and blood iPTH,clinical symptom improvement degree and other data were analyzed. RESULTS Postoperative, the levels of blood calcium, blood phosphorus and blood iPTH all decreased significantly compared with that before operation, and the difference was statistically significant(P <0.05). There was no significant difference in preoperative and postoperative levels of blood calcium, blood phosphorus and blood iPTH at 6 months after surgery between the two groups(P >0.05).Postoperative bone pain, skin itching and restless leg syndrome were significantly reduced in both groups. There was no significant difference in symptom relief between the two groups(P >0.05). CONCLUSION Both of the surgical methods can effectively manage the hyperparathyroidism secondary to uremia, they have high surgical safety, there was no significant difference in the effects of serum calcium and phosphorus between the two groups, and the parathyroid hormone decreased more significantly in the parathyroid total excision and forearm autologous transplantation group in the short term. Both of them have the possibility of recurrence. The second operation in total parathyroidectomy and forearm autotransplantation group is simple and easy,which has certain advantages.
OBJECTIVE To analyze and compare the clinical efficacy of subtotal-parathyroidectomy and totalparathyroidectomy with forearm autotransplantation in the treatment of hyperparathyroidism secondary to uremia.METHODS The clinical data of 31 cases of secondary hyperparathyroidism(SHPT) who were operated in Dalian Friendship Hospital from January 2012 to June 2018 were retrospectively analyzed. The cases were divided into two groups. Subtotal parathyroidectomy was performed in group one(20 cases) and total parathyroidectomy with forearm autotransplantation were performed in group two(11 cases). Preoperative, postoperative one week,1 month, 3 months, 6 months of patients with the levels of blood calcium, blood phosphorus and blood iPTH,clinical symptom improvement degree and other data were analyzed. RESULTS Postoperative, the levels of blood calcium, blood phosphorus and blood iPTH all decreased significantly compared with that before operation, and the difference was statistically significant(P <0.05). There was no significant difference in preoperative and postoperative levels of blood calcium, blood phosphorus and blood iPTH at 6 months after surgery between the two groups(P >0.05).Postoperative bone pain, skin itching and restless leg syndrome were significantly reduced in both groups. There was no significant difference in symptom relief between the two groups(P >0.05). CONCLUSION Both of the surgical methods can effectively manage the hyperparathyroidism secondary to uremia, they have high surgical safety, there was no significant difference in the effects of serum calcium and phosphorus between the two groups, and the parathyroid hormone decreased more significantly in the parathyroid total excision and forearm autologous transplantation group in the short term. Both of them have the possibility of recurrence. The second operation in total parathyroidectomy and forearm autotransplantation group is simple and easy,which has certain advantages.
引文
[1]Zou Q,Wang HY,Zhou J,et al.Total parathyroidectomy combined with partial auto-transplantation for the treatment of secondary hyperparathyroidism.Chin Med J(Engl),2007,120(20):1777-1782.
[2]Dotzenrath C,Cupisti K,Goretzki E,et al.Operative treatment of renal autonomous hyperparathyroidism:cause of persistent or recurrent disease in 304 patients.Langenbecks Arch Surg,2003,387(9):348-354.
[3]Nikodimopoulou M,Liakos S.Secondary hyperparathyroidism and target organs in chronic kidney disease.Hippokratia,2011,15(1):33-38.
[4]Adler JT,Sippel RS,Chen H.New trends in parathyroid surgery.Curr Probl Surg,2010,47(12):958-1017.
[5]冯嘉麟,周秦毅,陈隽,等.继发性甲状旁腺功能亢进外科治疗的疗效分析.中华耳鼻咽喉头颈外科杂志,2015,50(8):661-667.
[6]Kuo LE,Wachtel H,Karakousis G,et al.Parathyroidectomy in dialysis patients.J Surg Res,2014,190(2):554-558.
[7]Sakman G,Parsak CK,Balal M,et a1.Outcomes of total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy with routine addition of thymectomy to both groups:single center exper ience of secondary hyperparathyroidism.Balkan Med J,2014,31(1):77-82.
[8]Riss P,Asari R,Scheuba C,et a1.Current trends in surgery for renal hyperparathyroidism(RHPT)--an International survey.Langenbecks Arch Surg,2013,398(1):121-130.
[9]Mador in C,Owen RP,Fraser WD,et a1.The surgical management of renal hyperparathyroid ism.Eur Arch Otorhinolaryngol,2012,269(6):1565-1576.2018-11-11)
[2]Dotzenrath C,Cupisti K,Goretzki E,et al.Operative treatment of renal autonomous hyperparathyroidism:cause of persistent or recurrent disease in 304 patients.Langenbecks Arch Surg,2003,387(9):348-354.
[3]Nikodimopoulou M,Liakos S.Secondary hyperparathyroidism and target organs in chronic kidney disease.Hippokratia,2011,15(1):33-38.
[4]Adler JT,Sippel RS,Chen H.New trends in parathyroid surgery.Curr Probl Surg,2010,47(12):958-1017.
[5]冯嘉麟,周秦毅,陈隽,等.继发性甲状旁腺功能亢进外科治疗的疗效分析.中华耳鼻咽喉头颈外科杂志,2015,50(8):661-667.
[6]Kuo LE,Wachtel H,Karakousis G,et al.Parathyroidectomy in dialysis patients.J Surg Res,2014,190(2):554-558.
[7]Sakman G,Parsak CK,Balal M,et a1.Outcomes of total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy with routine addition of thymectomy to both groups:single center exper ience of secondary hyperparathyroidism.Balkan Med J,2014,31(1):77-82.
[8]Riss P,Asari R,Scheuba C,et a1.Current trends in surgery for renal hyperparathyroidism(RHPT)--an International survey.Langenbecks Arch Surg,2013,398(1):121-130.
[9]Mador in C,Owen RP,Fraser WD,et a1.The surgical management of renal hyperparathyroid ism.Eur Arch Otorhinolaryngol,2012,269(6):1565-1576.2018-11-11)