摘要
目的观察甲状旁腺全切加前臂移植术(PTX+AT)治疗慢性肾脏病(CKD)患者严重继发性甲状旁腺功能亢进(SHPT)的临床疗效。方法选择我院2011年2月～2012年7月难治性肾性SHPT行PTX+AT术并随访3个月以上的20例患者。观察手术前后甲状旁腺激素(iPTH)、血钙、磷、血红蛋白、相关临床症状的变化情况。结果 (1)20例患者顺利完成手术,18例患者行甲状旁腺全切加前臂移植术,2例患者术中仅发现并切除3枚甲状旁腺,未行前臂移植。(2)无一例出现手术并发症(喉神经损伤、呼吸困难、抽搐等)。所有患者术后第2天骨痛、皮肤瘙痒、乏力等临床症状均明显改善。(3)术后各时间点血钙、磷、iPTH较术前明显下降,术后3月红细胞压积(Hct)较术前显著提高,差异均有统计学意义。结论 PTX+AT对于治疗难治性肾性SHPT疗效明确,是一种安全、经济和有效的治疗手段,术前甲状旁腺的准确定位及术后及时调整血钙水平是治疗成功的关键。
Objective To observe the clinical efficacy of total parathyroidectomy with forearm autograft （PTX ＋ AT） on severe secondary hyperparathyroidism （SHPT） in patients with chronic kidney disease （ CKD）. Methods A total of 20 patients with refractory SHPT, who received the operation of PTX ＋ AT in our hospital from February 2011 to July 2012 and had been followed-up for more than 3months, were selected. The changes of serum iPTH, calcium, phosphorus, hemoglobin, and related clinical symptom were observed before and after the operation. Results The operations of all the 20 patients were performed successfully. Eighteen patients received total PTX ＋ AT, while the remaining 2 patients had 3 parathyroids found and removed during operations and without forearm autograft. No surgical complications such as laryngeal nerve damage, dyspnea, or twitch occurred. Clinical symptom including bone pain, skin pruritus, and fatigue of all the patients were alleviated at the 2nd day after operation. The concentrations of serum iPTH, calcium, and phosphate after operation decreased obviously （P 〈 0.05 ）. Hct increased significantly 3 months later after the operation （ P 〈 0. 05 ）. Conclusion Total PTX ＋ AT has certain efficacy on refractory SHPT in patients with CKD. It has been proved to be a safe, economical, and effective method. Accurate locating of the parathyroid before the operation and timely adjustment of serum calcium after the operation is crucial for the success of the treatment.
出处
《中国骨质疏松杂志》
CAS
CSCD
北大核心
2013年第2期166-169,163,共5页
Chinese Journal of Osteoporosis
基金
安徽省卫生厅临床技术应用项目(09C152)
安徽省肾脏病学会佳林豪基金资助项目(ahjlh201001)
