甲状旁腺切除术治疗维持性透析患者继发性甲状旁腺功能亢进15例临床分析

目的 探讨甲状旁腺切除术（parathyroidectomy,PTX）治疗维持性透析（maintenance dialysis,MD）患者继发性甲状旁腺功能亢进（secondary hyperparathyroidism,SHPT）的临床疗效. 方法 回顾性分析2007～2013年在南京军区福州总医院血液净化科接受PTX治疗的15例MD继发性甲状旁腺功能亢进患者的临床资料,比较手术前后血全段甲状旁腺激素（intact parathyroid hormone,iPTH）、血钙、血磷和碱性磷酸酶（alkaline phosphate,ALP）的变化,了解患者术前与SHPT有关的临床症状及术后改善情况. 结果 术后围手术期无严重并发症,仅有1位患者术后喉返神经一过性损伤.术后各时期（7天、1个月、3个月、6个月）血iPTH（93.9 pg/ml,195 pg/ml,83.2 pg/ml,61 pg/ml）较术前血iPTH（2269pg/ml）明显下降（P分别＜0.001,0.001,0.008,0.018）,与术前相比,术后血钙、血磷和ALP水平均明显下降（P＜0.05）.骨痛、骨折、关节畸形、皮肤瘙瘁、肌肉软弱无力和心悸等临床症状和体征有明显改善. 结论 PTX对于治疗MD难治性SHPT疗效明确,是一种安全可靠的治疗手段,但远期疗效有待于进一步随访.

Parathyroidectomy in the treatment of 15 maintenance dialysis patients with secondary hyperparathyroidism

Objective To investigate the clinical effect ofparathyroidectomy （PTX） on maintenance dialysis patients with refractory secondary hyperparathyroidism （SHPT）.Methods Fifteen refractory SHPT patients undergoing PTX treated in our hospital from 2007 to 2013 were retrospectively analyzed to compare serum intact parathyroid hormone （iPTH）,calcium,phosphate and alkaline phosphate （ALP） before and after the operation,and to assess the changes of hyperparathyroidism symptoms after PTX.Results No patient died in the perioperative period,but one patient had transient injury of recurrent laryngeal nerve.Serum iPTH was 2,269 pg/ml before PTX,and was 93.9,195,83.2,and 61 pg/ml after PTX for 7 days,1 month,3 months,and 6 months,respectively （P＜0.001,0.001,0.008 and 0.018,respectively,compared the value before PTX）.Serum iPTH,phosphorus,calcium and ALP decreased significantly after PTX （P＜0.05,compared the values before PTX）.Clinical symptoms and signs including bone pain,fractures,joint deformity,skin itching,muscle weakness and heart palpitations also improved remarkably after PTX.Conclusions Parathyroidectomy is a safe and reliable measure with confirmed effects for the treatment of uremia patients with SHPT.However,the long-term effects remain to be followed up.