摘要
目的 比较甲状旁腺次全切除术与亚次全切除术治疗尿毒症继发性甲状旁腺功能亢进症(Secondary hyperparathyroidism,SHPT)的临床疗效。方法 回顾性分析在2007年7月至2011年5月期间在广州市第一人民医院进行甲状旁腺次全切除术的SHPT患者18例,根据切除范围不同分两组,亚次全切组切除4个腺体中的3个,共8例;次全切组:切除3.5个腺体,共10例。观察术前及术后1天、1周、1个月、6个月的数据,包括血钙(Ca)、血磷(P)、钙磷乘积(Ca×P)、血清全段甲状旁腺素(iPTH)、碱性磷酸酶(ALP),以及临床症状的改善情况和相关并发症,比较两种手术的疗效。结果 两组患者术前彩超发现的甲状旁腺结节数、Ca、P、Ca×P、iPTH、ALP全部无统计学意义。全部患者在1周内疼痛症状均明显缓解,两组缓解时间、手术并发症无统计学意义;术前和术后Ca、P、Ca×P、iPTH、ALP两组均明显下降(P<0.05);两组间比较,Ca在术后1周、1个月,P和Ca×P在术后1周、1个月、6个月,iPTH在术后1天、1周、1个月、6个月,ALP在6个月,次全切组较亚次全切组均有显著下降(P<0.05)。结论 甲状旁腺次全切除术是治疗尿毒症继发性甲状旁腺功能亢进的有效方法,但术式上次全切除术比亚次全切除术更能减少持续性和复发性SHPT。
Objective To compare the efficacy of subtotal parathyroidectomy and less-than subtotal parathyroidectomy in uremic patients with secondary hyperparathyroidism (SHPT). Methods We retrospectively analyzed 18 patients subjected to parathyroidectomy in this hospital from July 2007 to May 2011. The patients were assigned into two groups: less-than subtotal parathyroidectomy group (n=8), in which 3 of the 4 glands were resected, and subtotal parathyroidectomy group (n=10), in which 3 and a half of the 4 glands were removed. Serum calcium (Ca), phosphorus (P), calcium-phosphorus product (Ca×P), intact parathyroid hormone (iPTH) and alkaline phosphatase (ALP), as well as changes of clinical symptoms and related complications were observed before operation and after the operation for one day, one week, one month and 6 months. Results No statistical differences were found in number of parathyroid nodules, serum Ca, P, Ca×P, iPTH and ALP before operation between the two groups. There were statistical differences in Ca, P, Ca×P, iPTH and ALP before and after operation in each group (P<0.05). In subtotal parathyroidectomy group, serum Ca was lower after operation for one week and one month (P<0.05), P and Ca×P were lower after operation for one week, one month and six months, iPTH was lower after operation for one day, one week, one month and six months, while ALP was lower after operation for six months, as compared with those of the less-than subtotal parathyroidectomy group. In both groups, pain symptoms relieved after operation for one week, without differences in relief time and operation complications between the two groups. Conclusion Subtotal parathyroidectomy is more effective than less-than subtotal parathyroidectomy for the treatment of persistent/recurrent hyperparathyroidism.
出处
《中国血液净化》
2012年第7期369-373,共5页
Chinese Journal of Blood Purification
