超声引导下经皮热消融治疗继发性甲状旁腺功能亢进的疗效

目的探讨超声引导下经皮微波或射频消融治疗继发性甲状旁腺功能亢进的疗效。方法选择2012年9月至2013年9月首都医科大学附属北京友谊医院56例尿毒症并继发性甲状旁腺功能亢进患者。消融前行超声造影明确患者甲状旁腺血供，并明确消融路径；于超声引导与超声造影监测下采用微波或射频电极针对患者增大的甲状旁腺进行消融治疗。以超声造影结果作为消融术中及消融结束的主要指标。观察并应用配对t检验比较患者术前、术后1d、术后1周、1个月、6个月及1年血清甲状旁腺激素（PTH）浓度。结果56例患者共消融增生甲状旁腺138枚。56例患者均完成1个月的随访，34例完成6个月的随访，12例完成1年的随访。其中2例患者术后情况特殊故未进行统计分析。术后54例患者术后1d血清PTH浓度为（369．5±183．4）ng／L，较术前的（1321．6±471．4）ng／L明显下降，且差异有统计学意义（t=10．727，P=0．000）；术后1周患者血清PTH浓度为（324．6±172．8）ng／L，与术后1d比较虽有所下降，但差异无统计学意义，而与术前比较则明显下降，且差异有统计学意义（t=364，P=0．000）；术后1个月患者血清唧浓度为（332．5±164．9）ngm，与术后1周比较虽有所上升，但差异无统计学意义，而与术前比较则明显下降，且差异有统计学意义（t=11．348，P=0．000）；术后6个月、1年患者血清PTH浓度分别为（205．2±136_3）、（177．1±171．5）ngm，均较术前明显下降，且差异均有统计学意义（t=8．737，P=0．000；t=7．655，P=0．017）。结论超声引导下经皮微波或射频消融治疗继发性甲状旁腺功能亢进是一种有效的治疗方法。

The efficacy of ultrasound guided percutaneous thermoablation for secondary hyperparathyroidism

Objective To explore the clinic value and efficacy of color Doppler ultrasound guided percutaneous microwave/radiorequency thermoablation for secondary hyperparathyroidism. Methods Fifty-six cases of secondary hyperparathyroidism who came from nephrology department of Beijing Friendship Hospital in the period of September 2012 to September 2013 were treated by color Doppler ultrasound guided percutaneous microwave/radiorequency thermoablation. One hundred and thirty-eight glands underwent this treatment and were evaluated by contrast enhanced ultrasound before, during and after operation. The levels of serum parathyroid hormone （PTH） were measured before and at 1 week, 1 month, 6 months and 1 year after treatment. Results The whole 56 cases achieved 1 month follow-up and 34 cases and 12 cases achieved 6 months and 1 year follow-up, respectively. Two special cases had been excluded. The PTH levels of 54 cases were significantly different between after and before treatment [（369.5 ±183.4） ng/L vs （1321.6±471.4） ng/L, t=-10.727, P=-0.000]. The PTH levels continued to fall at the first week after treatment, but there was no statistical significance between the first week and the first day after treatment [（324.6±172.8） ng/L vs （369.5 ±183.4） ng/L], while there was significantly different between the first week after treatment and before treatment [（324.6± 172.8） ng/L vs （1321.6±471.4） ng/L, t=-9.364, P=0.000]. The PTH levels increased from （324.6± 172.8） ng/L to （332.5 ±164.9） ng/L at 1 week and 1 month after ablation, while there was no significant difference.But there is significantly different between 1 month after treatment and before treatment （t=-11.348, P=0.000）. The PTH level at 6 months after treatment [（205.2±136.3） rig/L] and 1 year after treatment [（177.1 ± 171.5） ng/L] had significant difference compared with the value before treatment （t=-8.737, P=0.000; t=7.655, P=0.017）. Conelusion Color Doppler ultrasound guided percutaneous microwave/ radiorequency thermoablation can be considered as a feasible and effective nonsurgical altemative treatment for secondary hyperparathyroidism patients.