甲状旁腺全切加前臂移植治疗难治性肾性甲状旁腺功能亢进的疗效观察

目的 观察甲状旁腺全切加前臂移植术（PTX+AT）治疗慢性肾脏病（CKD）患者严重继发性甲状旁腺功能亢进(SHPT)的临床疗效。方法 选择我院2011年2月~2012年7月难治性肾性SHPT行PTX+AT术并随访3个月以上的20例患者。观察手术前后甲状旁腺激素(iPTH)、血钙、磷、血红蛋白、相关临床症状的变化情况。结果 （1）20例患者顺利完成手术,18例患者行甲状旁腺全切加前臂移植术,2例患者术中仅发现并切除3枚甲状旁腺,未行前臂移植。（2）无一例出现手术并发症（喉神经损伤、呼吸困难、抽搐等）。所有患者术后第2天骨痛、皮肤瘙痒、乏力等临床症状均明显改善。（3）术后各时间点血钙、磷、iPTH较术前明显下降,术后3月红细胞压积（Hct）较术前显著提高,差异均有统计学意义。结论 PTX+AT对于治疗难治性肾性SHPT疗效明确,是一种安全、经济和有效的治疗手段,术前甲状旁腺的准确定位及术后及时调整血钙水平是治疗成功的关键。     

50例尿毒症继发性甲状旁腺功能亢进患者的手术疗效分析

目的探讨不同的甲状旁腺切除术(PTX)治疗尿毒症继发性甲状旁腺功能亢进(SHPT)的疗效。方法收集2016年1月至2018年3月期间在武汉大学人民医院接受PTX的50例SHPT患者的临床资料,比较患者术前及术后1和7 d及1、3、12个月时的血清全段甲状旁腺激素(iPTH)、血钙及血磷的变化,并观察治疗后临床症状的变化、术后并发症及复发情况。结果 50例患者中行甲状旁腺次全切除术(SPTX)10例、甲状旁腺全切除术(TPTX)5例及TPTX+自体移植术(TPTX+AT)35例。47例(94.0%)患者手术成功,3例患者未成功,3种手术方式中各有1例手术未成功(χ~2=3.351,P=0.211)。术后患者骨痛、瘙痒等症状均缓解。有3例发生一过性喉返神经损伤,1例发生甲状旁腺功能减退,38例术后发生低钙血症。患者术后不同时相的iPTH、血钙及血磷水平较术前明显降低(P0.050)。术后3及12个月时的复发率分别为10.0%(5/50)及9.1%(2/22),术后3个月时SPTX、TPTX+AT、TPTX分别有1、3及1例复发(χ~2=1.321,P=0.753),术后12个月时SPTX、TPTX+AT及TPTX分别有1、1及0例复发(χ~2=1.794,P=0.411)。结论目前国内治疗尿毒症SHPT最常用的术式为TPTX+AT,SPTX和TPTX同样安全、有效,也可改善患者各项指标,提高生存质量,可根据患者具体情况个体化选择。     

多学科协作围手术期管理下尿毒症继发甲状旁腺功能亢进两种术式的对比研究

目的：探讨多学科协作管理下尿毒症继发甲状旁腺功能亢进（SHPT）行甲状旁腺全切除术（TPTX）与TPTX+自体移植（AT）的对比研究。方法：通过多学科协作下对TPTX与TPTX+AT两组患者术后血钙、血磷、全段甲状旁腺激素（i PTH）、左室射血分数、两室心室结构、心脏瓣膜钙化、血钙钙化、手术时间、出血量、住院费用进行比较。结果：TPTX组复发率明显低于TPTX+AT组（P<0.05）,甲状旁腺功能减退发生率TPTX+AT组低于TPTX组（P<0.05）,口周麻木及抽搐发生率两组相比差异无统计学意义（P>0.05）。两组患者术后血钙、血磷及i PTH较术前均有明显下降（P<0.05）,其中术后血钙及i PTH两组差异均无统计学意义（P>0.05）;术后1个月至术后1年,TTPX组血磷控制明显较TPTX+AT组低（P<0.001）。两组左室射血分数随时间延长有增加趋势（P<0.05）,但两组间相比差异无统计学意义（P>0.05）;两组心室结构均呈下降趋势（P<0.05）,但两组相比差异无统计学意义（P>0.05）;两组心脏瓣膜钙...     

甲状旁腺全切除自体前臂移植术治疗肾功能不全继发性甲状旁腺功能亢进

目的:研究甲状旁腺全切除(PTX)自体前臂移植术治疗慢性肾功能衰竭继发性甲状旁腺功能亢进(SHPT)的疗效和安全性。方法:回顾性分析2011年12月—2015年12月接受PTX自体前臂移植的30例慢性肾功能衰竭终末期并SHPT患者的临床资料,观察患者术后临床症状改善情况、血清全段甲状旁腺激素(iPTH)、钙、磷及钙磷乘积的变化,以及术后并发症与复发情况。结果:所有患者均手术成功。术后患者临床症状均明显改善;血清iPTH、钙、磷及钙磷乘积水平均较术前明显降低(均P0.05)。12例患者出现一过性喉返神经损伤,均自行好转。术后8例(2.7%)复发,7例再次手术后症状缓解。结论:PTX自体前臂移植术是治疗慢性肾功能衰竭SHPT的一种安全有效的方法。     

原发性甲状旁腺功能亢进术后低钙血症相关因素分析

目的 探讨原发性甲状旁腺功能亢进术后出现低钙血症及其症状的相关因素。方法 收集2009年1月至2015年3月北京协和医院行手术治疗的原发性甲状旁腺功能亢进病人临床资料,分析与术后低钙血症及其症状相关的临床因素。 结果 641例原发性甲状旁腺功能亢进病人成功接受甲状旁腺切除术治疗,并得到术后病理学诊断及长期随访证实。118例（18.4%）术后第一日血清总钙低于正常值下限,210例（32.8%）出现低钙血症相关的临床症状。多因素相关分析发现：原发性甲状旁腺病人术后出现低钙血症相关症状,与病人年龄、术前血清无机磷及碱性磷酸酶（ALP）相关;术后第一日血清总钙水平低于正常与术前血清全片段甲状旁腺激素（iPTH）水平相关。 结论 青年病人、术前血清iPTH和ALP水平增高、血清无机磷水平低可能是原发性甲状旁腺功能亢进术后低钙的相关因素。     

血液透析患者甲状旁腺全切除加上臂移植术后低钙血症的防治

目的 观察因继发性甲状旁腺功能亢进症（secondary hyperparathyroidism,SHPT）进行甲状旁腺全切除加上臂移植术（total parathyroidectomy with upper arm autograft,TPTX＋AT）的血液透析患者,术后使用不同钙离子浓度的透析液行透析治疗低钙血症的效果,探讨如何更有效防治术后低钙血症.方法 选择2011年3月至2013年6月在我院接受TPTX＋AT的血液透析患者29例,按照手术时间的先后顺序进行编号,随机将偶数分在A组14例,奇数分在B组15例.术前B组补钙及骨化三醇;术后2组均予补钙及骨化三醇.A组使用钙浓度1.50 mmol/L透析液,B组使用钙浓度1.75 mmol/L高钙透析液.观察术后8 h、24 h、48 h、1周、2周及4周的血钙、血磷及甲状旁腺素（intact parathyroid hormone,iPTH）的变化,记录低钙血症的临床症状,术后达到治疗目标所需要的时间及静脉补钙量.结果 术后血钙、血磷、iPTH均明显下降.术后低钙血症主要表现四肢末端发麻,全身无力,焦虑、烦躁;少数患者表现为心悸、多汗、肌肉痉挛、四肢抽搐,血压低、腹痛或腹泻.A组低钙血症发生率为 85.7%（12/14）、B组为 73.3%（11/15）.术后1周B组血钙水平[（1.95±0.18）mmol/L]明显高于A组[（1.76±0.21）mmol/L].B组术后达到治疗目标所需要的时间为[（7.56±2.25）d],少于A组[（10.54±3.12）d];而B组所需静脉补钙量[（6.86±2.13）g]少于A组[（9.28±2.81）g],差异均有统计学意义（P＜0.05）.结论 并发SHPT的血液透析患者在TPTX＋AT术后常会出现低钙血症,术前、术后足量补充钙剂和骨化三醇,术后使用高钙透析液透析能更加有效防治低钙血症.     

甲状旁腺次全切除术和甲状旁腺全切除加甲状旁腺自体移植术治疗尿毒症后继发性甲状旁腺功能亢进的疗效

目的 比较尿毒症后继发性甲状旁腺功能亢进（SHPT）行甲状旁腺次全切除术（sPTX）和甲状旁腺全切除（tPTX）加甲状旁腺自体移植（AT）术的疗效。方法 回顾性分析2005年2月至2012年9月期间中国人民武装警察部队新疆生产建设兵团指挥部后勤部医院及新疆维吾尔自治区人民医院行tPTX＋AT （n=57）和sPTX （n=19） 的76例尿毒症后SHPT患者的临床资料,比较2种术式的疗效。结果 76例患者手术成功68例（89.5%）,切除不足8例（10.5%）。76例患者术后骨痛均缓解,皮肤瘙痒症状改善14例（26.9%,14/52）。tPTX＋AT组术后1 d、7 d及6个月的血钙水平均较低（P＜0.05）,术后6个月的iPTH水平较低（P＜0.05）。2组患者的手术时间、术中出血量、住院时间及住院费用比较差异均有统计学意义,tPTX＋AT组均较长或较高（P＜0.05）。术后76例患者均获访,随访时间为6～18个月,中位数为8.7个月。其中tPTX＋AT组死亡2例,复发2例;sPTX组死亡1例,复发7例。sPTX组的复发率较高（P＜0.05）。结论 尿毒症后SHPT行tPTX＋AT的术后1年内复发率较低,行sPTX者更易发生术后复发;但tPTX＋AT组的手术时间、术中出血量、住院时间及住院费用更高（更长或更多）。 2种术式各有优劣,术式选择时需根据情况综合判定。     

尿毒症继发性甲状旁腺功能亢进外科治疗的对比分析

目的 对比分析甲状旁腺全切除术(TPTX)及甲状旁腺全切除术联合甲状旁腺自体移植术(TPTX+AT)治疗尿毒症继发性甲状旁腺功能亢进(SHPT)的临床疗效.方法 收集2015年6月-2019年7月于成都医学院第一附属医院进行TPTX或TPTX+AT的SHPT的病例82例,根据手术方式分为TPTX组和TPTX+AT组.T...     

甲状旁腺全切并自体前臂移植术治疗肾性难治性继发性甲状旁腺功能亢进疗效随访分析

目的观察甲状旁腺全切加自体前臂移植术(total parathyroidectomywith forearm autograft,PTX+AT)治疗肾性难治性继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的临床疗效。方法分析2011年2月至2013年12月安徽医科大学第二附属医院终末期肾脏疾病(end stage renal disease,ESRD)合并SHPT行PTX+AT随访6个月以上患者93例。收集患者术前和术后第1、3及6个月血钙、血磷、全段甲状旁腺素(intact parathyroid hormone,iPTH)、碱性磷酸酶(alkaline phosphatase,ALP)、血红蛋白(hemoglobin,Hb)及血细胞比容(hematocrit,Hct),测量相应时间患者血压,统计并分析结果;记录症状缓解、术后并发症及复发情况。结果①手术及并发症:成功手术93例,7例发生一过性喉返神经损伤,随访3个月均恢复。低钙血症发生率为80.6%(75/93),静脉或口服补钙有效。②症状缓解:大多数患者术后骨痛(74/76)、皮肤瘙痒(26/26)和失眠(18/18)症状次日即基本缓解,短期内仍有骨痛者2例,3个月后缓解。肌无力、纳差及全身营养状况逐渐改善。③血生化指标及血压:术后贫血改善,重组人红细胞生成素用量减少(P0.05)。与术前相比,患者术后血钙、血磷、iPTH水平下降,差异均有统计学意义(P0.01)。血钙、血磷及iPTH于术后第3个月开始缓慢升高,平均值达指南推荐水平。合并高血压病患者74例,49例术后血压得到有效控制,总有效率达66.2%。④复发及二次手术:7例复发,复发率为7.5%,其中3例为前臂种植部位复发,行种植部位甲状旁腺手术切除后缓解;4例为残留或异位甲状旁腺所致复发(其中3例已再次行PTX,1例手术失败,2例未再复发;1例因甲状旁腺异位于主动脉弓上方未再手术治疗)。结论 PTX+AT治疗肾性难治性SHPT疗效明确,骨痛、瘙痒及失眠症状迅速缓解,明显改善贫血、提高血压控制率并使血钙、血磷、iPTH达理想水平,是一种安全、经济和有效的治疗手段。     

尿毒症继发性甲状旁腺亢进两种手术方式的疗效比较

目的：比较甲状旁腺次全切除与甲状旁腺全切除加自体前臂种植术治疗尿毒症维持性血透患者严重、继发性甲状旁腺功能亢进（SHPT）的临床疗效。方法：对2002年8月~2007年12月期间在我院接受甲状旁腺切除术13例患者资料（甲状旁腺次全切6例,甲状旁腺全切加自体前臂种植7例）进行回顾性分析,包括定位诊断,以及手术前后完整甲状旁腺激素（iPTH）、血钙、血磷、钙磷乘积、红细胞比容（Hct）进行比较。结果：术前分别行B超和颈部放射性核素显像断层扫描（ECT）的6例患者,B超对肿大甲状旁腺的检出率明显高于ECT。两组患者组内iPTH术后（3d,1周,1月,3月）较术前有明显的下降,有统计学意义;术后血钙、血磷及其乘积较术前明显下降,有统计学意义;术后Hct与术前水平接近,无统计学意义。两组间术前、术后iPTH及血钙、血磷、钙磷乘积水平接近,无统计学意义。结论：在两种术式均能有效的治疗SHPT和均有复发可能的情况下,甲状旁腺全切除加自体前臂种植术的二次手术简单易行,有一定的选择优势。     

Effect of different surgical procedures of parathyroidectomy on secondary hyperparathyroidism: a meta-analysis

Objective To evaluate the effect of total parathyroidectomy and autotransplantation (TPTX+AT) and total parathyroidectomy (TPTX) on secondary hyperparathyroidism (SHPT). Methods PubMed, EMBASE and Cochrane library were searched from inception to June 2017 for relative studies, which were screened according to inclusion criteria. Meta-analysis of included study were conducted to compare the improvement of symptoms, persistent SHPT, recurrent SHPT, reoperation, hypoparathyroidism, duration of operation and hospitalization between TPTX+AT group and TPTX group. Results A total of 11 studies with 1212 patients were included. Results of meta-analyses showed no difference between TPTX+AT and TPTX regarding improvement of symptoms and persistent SHPT (RR=1.03, P=0.70; RR=0.81, P=0.67, respectively), but TPTX was associated with lower risks of recurrent SHPT and reoperation (RR=0.25, P＜0.01; RR=0.19, P＜0.01). Patients with TPTX had higher rate of hypoparathyroidism (RR=2.68, P＜0.01) but shorter time of operation (MD=-17.3, P=0.01). Durations of hospitalization were similar between the two groups (MD=-0.06, P=0.98). Conclusion Compared with TPTX+AT, TPTX reduces the risks of recurrent SHPT, reoperation and operation time, but has higher risk of hypoparathyroidism.     

Correlation between pathological types of parathyroid and clinical manifestations in patients with renal secondary hyperparathyroidism

Objective To analyze the correlation between the pathological types of parathyroid and clinical manifestations in patients with renal secondary hyperparathyroidism (SHPT), so as to improve the efficacy and safety of treatment. Methods The pathological and clinical data of 130 patients with renal SHPT and maintenance hemodialysis (MHD) who had undergone total parathyroidectomy with autotransplantation (TPTX+AT) were collected. A total of 545 parathyroid glands were obtained and 998 slices were made and read. According to the pathological types of parathyroid hyperplasia, the patients were divided into diffuse hyperplasia (DH) group, diffuse between hyperplasia and nodular hyperplasia (DH/NH) group as well as nodular hyperplasia (NH) group. The clinical and biochemical characteristics of different groups before and after operation (1-, 3-, 6-, 9-, 12-month) were compared and analyzed by statistical tests. Results (1) The preoperative status: the dialysis age, serum calcium as well as incidence of bone pain, skin itching and shorten height in the NH group were significantly higher than those in the DH group (all P＜0.05), and the serum phosphorus and iPTH in the NH group were significantly higher than those in DH and DH/NH group (all P＜0.05). (2) The postoperative status: the serum calcium of the NH group at 1-month was lower than that of the DH group, and the incidence of hypocalcemia of the NH group at 1-month was higher than that of the DH group (P＜0.05); the serum phosphorus at 3-, 6-, 9-month and iPTH at 1-, 3-month of the NH group were significantly lower than that of the DH group (all P＜0.05), and the serum phosphorus at 3-month and iPTH at 1-month of the NH group were lower than that of the DH/NH group (all P＜0.05). Among the 3 groups the serum phosphorus change from 1 to 12 months had difference (F=3.241, P=0.042), while the differences of serum calcium and iPTH changes were statistically insignificant. Conclusions The clinical manifestations, serum calcium, phosphorus and iPTH in patients with renal SHPT before and after TPTX+AT are closely related to the pathological types of parathyroid hyperplasia. Compared with the DH patients, before the operation the NH patients have longer dialysis age, more serious the clinical symptoms such as bone disease, higher calcium, phosphorus and iPTH, while greater reduction of the serum calcium, phosphorus and iPTH in the short term after operation.     

甲状旁腺全切＋自体移植术治疗继发性甲状旁腺功能亢进症疗效分析

目的探讨甲状旁腺全切＋自体移植术(tPTX＋AT)治疗维持性血液透析患者继发性甲状旁腺功能亢进症(SHPT)的有效性、安全性以及术后低钙的危险因素。 方法纳入我院2013年1月至2016年11月因SHPT行tPTX＋AT手术的维持性血液透析患者93例,收集术前术后症状、血钙、磷、碱性磷酸酶(ALP)、全段甲状旁腺激素(iPTH)、病理类型、并发症等临床资料。依据术后24 h血钙水平分为正常血钙组(Ca≥2.11 mmol/L)及低钙血症组(Ca<2.11 mmol/L),应用单因素分析及逐步Logistic回归分析术后早期低钙血症的危险因素。 结果手术成功率92.5%。切除360枚甲状旁腺腺体,异位甲状旁腺10枚。病理结果多为腺瘤样增生(96.4%)。同术前相比,术后血清iPTH、磷、ALP明显下降(P<0.05)。低钙血症是术后最常见并发症,发生率82.8%,血钙水平与术前血钙、年龄正相关(r＝0.300, P<0.01;r＝0.265, P<0.01),与术前iPTH、ALP水平负相关(r＝－0.461, P<0.01;r＝－0.477, P<0.01)。术前低血钙(OR＝0.113, P＝0.045)、高ALP水平(OR＝1.050, P<0.001)、高iPTH水平(OR＝1.002, P＝0.004)是术后早期低钙血症发生的独立危险因素。 结论tPTX＋AT可以安全、有效、快速的降低维持性血液透析患者血清iPTH水平,改善机体的钙磷代谢紊乱,但需重视并积极纠正术后低钙血症。针对存在术前低血钙、高iPTH及高ALP水平等高危因素的患者,术前积极纠正低钙血症可能是预防术后低钙的有效干预方式。     

甲状旁腺切除术对肾性继发性甲状旁腺功能亢进患者NLR、PLR的影响

目的 探讨甲状旁腺切除术对肾性继发性甲状旁腺功能亢进(secondary hyperpar-athyroidism,SHPT)患者中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、血小板/淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)的影...     

Intravenous calcitriol regresses myocardial hypertrophy in hemodialysis patients with secondary hyperparathyroidism

To evaluate the response of circulating intact parathyroid hormone (iPTH) on myocardial hypertrophy in hemodialysis (HD) patients with secondary hyperparathyroidism (SHPT), echocardiographic and neurohormonal assessments were performed over a 15-week period in 15 HD patients with SHPT before and after calcitriol treatment and 10 HD control patients with SHPT not receiving calcitriol therapy. We prospectively studied a group of 15 patients with significantly elevated iPTH levels (iPTH >450 pg/mL) receiving calcitriol (2 microg after dialysis twice weekly). Clinical assessment, medication status, and biochemical and hematological measurements were performed once a month. Throughout the study, calcium carbonate levels were modified to maintain serum phosphate levels at less than 6 mg/dL, but body weight, antihypertensive medication, and ultrafiltration dose remained constant. In patients treated with calcitriol, an adequate reduction of iPTH levels was found (1,112 +/- 694 v 741 +/- 644 pg/mL; P < 0.05) without changes in values of serum ionized calcium (iCa++), phosphate, or hematocrit. Blood pressure (BP), cardiac output (CO), and total peripheral resistance (TPR) did not significantly change. After 15 weeks of treatment with calcitriol, M-mode echocardiograms showed pronounced reductions in interventricular wall thickness (13.9 +/- 3.6 v 12.8 +/- 3.10 mm; P = 0.01), left ventricular posterior wall thickness (12.5 +/- 2.4 v 11.3 +/- 1.8 mm; P < 0.05), and left ventricle mass index (LVMi; 178 +/- 73 v 155 +/- 61 g/m2; P < 0.01). However, in control patients, these changes were not found after the treatment period. In addition, sequential measurements of neurohormonal mediator levels in patients receiving calcitriol showed that plasma renin (18.5 +/- 12.7 v 12.3 +/- 11.0 pg/mL; P = 0.007), angiotensin II (AT II; 79.7 +/- 48.6 v 47.2 +/- 45.7 pg/mL; P = 0.001), and atrial natriuretic peptide (ANP; 16.6 +/- 9.7 v 12.2 +/- 4.4 pg/mL; P = 0.03) levels significantly decreased, whereas antidiuretic hormone (ADH), epinephrine, and norepinephrine levels did not change significantly. The percent change in LVMi associated with calcitriol therapy had a strong correlation with the percent change in iPTH (r = 0.52; P < 0.05) and AT II (r = 0.47; P < 0.05) levels. We conclude that the partial correction of SHPT with intravenous calcitriol causes a regression in myocardial hypertrophy without biochemical or hemodynamic changes, such as heart rate, BP, and TPR. The changes in plasma levels of iPTH and, secondarily, plasma levels of neurohormones (especially AT II) after calcitriol therapy may have a key role in attenuating ventricular hypertrophy in SHPT.     

Endoscopic Total Parathyroidectomy and Partial Parathyroid Tissue Autotransplantation for Patients with Secondary Hyperparathyroidism: A New Surgical Approach

Background  Secondary hyperparathyroidism (SHPT) (i.e., renal hyperparathyroidism) is one of the most serious complications in long-term hemodialysis patients. The purpose of this retrospective study was to explore the feasibility of a new surgical approach—endoscopic total parathyroidectomy with autotransplantation (ETP+AT)—and evaluate its practical application for patients with SHPT. Methods  The study included 34 SHPT patients who underwent ETP+AT from among 67 cases at the Department of Minimally Invasive Surgery, the First Affiliated Hospital of Nanjing Medical University over a 3-year period. The other 33 patients underwent traditional total parathyroidectomy with autotransplantation (TP+AT). Two criteria were used as indications to perform ETP+AT in SHPT patients. The first was a high serum parathyroid hormone level (PTH >800 pg/ml) associated with hypercalcemia and/or hyperphosphatemia that which were refractory to medical treatment. The second criterion was the presence of clinical symptoms including pruritus, bone and joint pain, muscle weakness, progression of soft tissue calcification, and spontaneous fractures. Ultrasonography, ^99mTc sestamibi scans, and computed tomography were used to evaluate the thyroid and parathyroid glands. Results  There was no surgery-related mortality among any of the patients with ETP+AT. One patient underwent conventional neck exploration because of bleeding and injury of a unilateral recurrent laryngeal nerve after the operation. Preoperative symptoms were alleviated, and the serum PTH and alkaline phosphatase levels, hyperphosphatemia, and hypercalcemia were improved or normalized in most patients. Recurrence was observed in one patient with a sixth parathyroid gland behind his thyroid, and the patient required a second operation. Hypoparathyroidism was not found after the operation. The clinical data were compared between ETP+AT and TP+AT. Conclusions  ETP+AT is a safe option for the treatment of SHPT with low morbidity and mortality, shorter hospital stay and low recurrence rate. It is important to avoid intraoperative bleeding, identify all parathyroid glands during the surgery, and choose adequate parathyroid tissues for autografting.     

甲状旁腺切除术对尿毒症患者难治性继发性甲旁亢的疗效观察

目的回顾性统计尿毒症难治性继发性甲状旁腺功能亢进患者进行甲状旁腺切除术的临床疗效。方法监测并统计12例人组患者术前及术后1个月、3个月、半年、1年的血钙、磷、全段甲状旁腺素及临床症状。结果全切＋自体移植7例,次全切5例。次全切患者均复发,改用药物保守治疗仍部分有效。全切＋自体移植中5例术后1年持续低全段甲状旁腺素,为（61．31±21．11）pg／ml（38～89．91pg／ml）。常见足跟疼痛以及下肢承重关节相关的临床表现。术后无论何种术式及是否复发,患者除不宁腿综合征以外的症状均改善或明显改善,且其3个月、6个月及1年时症状及生化指标均较术前有明显改变。结论手术能明显缓解难治性患者的症状及生化水平,但长期来看存在可能复发及长期低全段甲状旁腺素的问题。