肾性继发性甲状旁腺功能亢进外科手术疗效分析

目的 探讨并比较甲状旁腺次全切除术和甲状旁腺全切加前臂移植术治疗肾性继发性甲状旁腺功能亢进的临床疗效。方法 回顾性分析15例患者资料，其中11例行甲状旁腺次全切除术（Ⅰ组），4例行甲状旁腺全切加前臂移植术（Ⅱ组），比较术前、术后第1天和6个月患者血PTH、血钙水平及临床症状改善情况。结果 Ⅰ、Ⅱ组患者术后第1天及6个月血PTH较术前均有显著下降，配对t检验差异有统计学意义（Ⅰ组：P值分别为0.0007、0.0002，P＜0.05；Ⅱ组：P值分别为0.0116、0.0196，P＜0.05），两组PTH手术前后差值进行两独立样本t检验，差异无统计学意义（第1天：P＝0.2670＞0.05；6个月：P＝0.4920＞0.05）。结论 对内科治疗无效的肾性继发性甲状旁腺功能亢进患者，甲状旁腺次全切除术及甲状旁腺全切＋前臂移植术都是有效的治疗方法，且两种手术方式在术后短期内（术后1天及6个月）的治疗效果无统计学差异。

Effect of surgeries for secondary hyperparathyroidism

Objective To evaluate the effects of subtotal-patathyroidectomy and total-parathyroidectomy with parathyroid tissue transplantation in the forearm in treatment of severe secondary hyperpathyroidism. Methods The clinical data of 11 patients subjected to subtotal-patathyroidectomy (group Ⅰ) and 4 patients subjected to total-parathyroidectomy with parathyroid tissue transplantation in the forearm (group Ⅱ) were retrospectively analyzed. The PTH and Ca levels before the operations, and 1 day and 6 months after the operations were determined. Results The PTH level was remarkably decreased after operations but there was no significant difference between the post-operative 1 day and the post-operative 6 month groups. The Ca level was also significantly decreased after the operations but it only had statistic significances in group Ⅰ. Conclusion Both subtotal parathyroidectomy and total parathyroidectomy with parathyroid tissue transplantation in the forearm have therapeutic effects for renal secondary hyperparathyroidism and the effects had no significant differences in the short term.