摘要
目的:研究甲状旁腺全切加自体移植术(total parathymidectomy with autotransplanration,tPTX+AT)在慢性肾功衰竭(尿毒症期)并发继发甲状旁腺功能亢进(secondary hyperparcthyroidism,SHPT)的外科治疗中的疗效及评价。方法:回顾性分析2017-01~2018-01在哈尔滨市第一医院普外四科接受tPTX+AT的72例SHPT患者手术前后的临床资料,血钙、血磷及甲状旁腺激素(parathyroid hormone,PTH)和临床症状变化情况,随访到出院3个月。结果:72例接受tPTX+AT的患者切除甲状旁腺共291枚,出院时皮肤瘙痒和周身骨痛等主要症状缓解或消失。术后3h血清钙(2.14±0.25)mmol·L^-1、血清磷(2.48±0.67)mmol·L^-1和PTH(37.63±42.30)ng·L^-1,较术前明显下降,差异有统计学意义(P<0.001),术后5d、1个月及3个月血清钙、磷和PTH与术后3h比较差异不明显没有统计学意义(P>0.05)。随访患者出院后1例发生低钙血症,2例术后复发再次入院切除前臂移植物。结论:SHPT患者接受tPTX+AT治疗后可以有效改善患者术前症状,降低术前血钙、血磷和PTH水平,并且安全有效。
Objective:To investigate the effect of total parathyroidectomy plus autotransplantation in the treatment of chronic renal failure(uremia stage)with secondary hyperparathyroidism.Methods:A retrospective analysis in January 2017 to January 2018 in the first hospital of Harbin four families received total resection of the parathyroid gland outside plus autologous transplantation treatment of 72 cases of chronic renal failure(uremia period)complicated by secondary hyperparathyroidism before and after surgery in patients with clinical data,blood calcium and blood phosphorus,parathyroid hormone and clinical symptoms and were followed up for 3 months.Results:A total of 291 parathyroid glands were removed in 72 patients,and the main symptoms such as pruritus and bone pain were relieved or disappeared.The serum calcium(2.14±0.25)mmol/L,serum phosphorus(2.48±0.67)mmol/L and parathyroid hormone(37.63±42.30)ng/L decreased significantly 3 hours after the operation compared with that before the operation,with statistically significant differences(P<0.001).There was no significant difference in serum calcium,phosphorus and parathyroid hormone between 5 days,1 month and 3 months after surgery and 3 hours after surgery(P>0.05).After follow-up,1 patient developed hypocalcemia after discharge,and 2 patients were readmitted for forearm graft resection after recurrence.Conclusion:Total parathyroidectomy combined with autotransplantation can effectively improve the preoperative symptoms of patients with chronic renal failure(uremia phase)and secondary hyperparathyroidism,and reduce the preoperative serum calcium,phosphorus and PTH levels.Safe and effective.
作者
姚赫原
李晓阳
YAO Heyuan;LI Xiaoyang(Graduate Department of Mudanjiang Medical College, Mudanjiang 157000, China;Harbin First Hospital, Harbin 150010, China)
出处
《黑龙江医药科学》
2019年第6期45-48,共4页
Heilongjiang Medicine and Pharmacy
基金
牡丹江医学院研究生创新科研项目,编号:2018YJSCX-19MY
哈尔滨市科技创新人才研究项目,编号:2015RAXYJ055。
作者简介
姚赫原(1993~)男,黑龙江佳木斯人,在读硕士研究生;通讯作者:李晓阳(1960~)男,黑龙江哈尔滨人,博士,主任医师,教授,E-mail:lixiaoyang160@126.com。
