超声引导下治疗继发性甲状旁腺亢进的价值

目的 探讨超声引导下甲状旁腺内注射1.25(OH)2D3治疗继发性甲状旁腺旁功能亢进的临床应用价值。方法 选择51例继发性甲状旁腺功能亢进患，于超声引导下局部甲状旁腺内注入1.25(OH)2D3。结果 甲状旁腺体积缩小，血清PTH降低。结论 超声引导下局部注射1，25(OH)2D3治疗继发性甲旁亢是有效、安全、副作用少的治疗方法，具有很好的临床应用价值。     

超声引导下无水乙醇治疗继发性甲状旁腺功能亢进

目的探讨彩色多普勒超声引导下无水乙醇治疗继发性甲状旁腺功能亢进临床效果及应用价值。方法观察分析23例超声引导下无水乙醇治疗继发性甲状旁腺功能亢进患者治疗前后超声声像图改变,以及血清甲状旁腺激素(PTH)水平等变化。结果增生的甲状旁腺注入无水乙醇后回声增强,腺体体积缩小[(2.1±0.6)cm3,(1.3±0.5)cm3,t=8.41,P<0.01],彩色血流减少,血清PTH水平降低[(908±408)ng/L,(491±225)ng/L,t=9.55,P<0.01]。结论超声引导下无水乙醇治疗继发甲状旁腺功能亢进是一种有效、安全、副作用少的介入治疗方法,具有重要的临床应用价值。     

继发性甲状旁腺功能亢进超声引导介入治疗现状及进展

甲状旁腺功能亢进是指各种原因导致甲状旁腺激素（parathyroidhormone,PTH）分泌过多而引起的钙磷比例失调和骨代谢紊乱的一种全身性疾病,分为原发性和继发性两种。原发性甲状旁腺功能亢进（primaryhyperparathyroidism,PHPT）主要病因是甲状旁腺腺瘤、腺癌和甲状旁腺增生;继发性甲状旁腺功能亢进（secondaryhyperparathyroidism,SHPT）主要病因是慢性肾功能衰竭。本文主要对最常见的SHPT超声介入治疗现状及进展作一综述。     

超声引导下PTC针穿刺无水乙醇注射治疗继发性甲状旁腺功能亢进的临床观察

目的观察终末期肾衰竭患者继发性甲状旁腺功能亢进使用超声引导下PTC针穿刺无水乙醇注射治疗的疗效。方法选择28例维持性血液透析继发性甲状旁腺功能亢进(iPTH≥44 pmol/mL)的患者,在超声引导下使用PTC针进行甲状旁腺穿刺,无水乙醇注射治疗,观察注射前后iPTH、碱性磷酸酶、血清钙、磷及多普勒超声甲状旁腺血流的变化。结果 PEITP治疗前后对比iPTH明显下降,皮肤瘙痒明显缓解,骨关节痛减轻,甲状旁腺增生腺体的血流明显减少。有明显统计学差异。结论 PEITP技术目前在开展甲状旁腺切除(PTX)条件不够的单位依然是治疗难治性SHPT的有效方法。     

继发性甲状旁腺功能亢进的超声图像分析

目的：为了给临床诊断、治疗继发性甲状旁腺功能亢进（甲旁亢）提供可靠依据,观察分析继发性甲状旁腺增生的多普勒超声图像特点。方法：运用高频彩色多普勒超声观察、分析42例肾功能衰竭患者临床确诊的继发甲旁亮患者增生的甲状旁腺。结果：共检出31例患者76个甲旁腺增大,内呈低无回声;其周围及内部有丰富的动静脉血流。结论：1.超声检查甲状旁腺可为临床诊断治疗甲旁亢提供可靠信息;2.增生的甲状旁腺主要应与甲状旁腺腺瘤与颈部淋巴结鉴别;3.甲状腺疾病与异位甲状旁腺可影响超声对增生的检出甲旁腺。     

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。     

超声对继发性甲状旁腺功能亢进的诊断价值

目的为探讨高分辨力超声对继发性甲状旁腺功能亢进（ＨＰＴ）的诊断价值。方法本文对３０例尿毒症血透病人进行甲状旁腺的超声检查,并结合ＰＴＨ、血钙、血肌酐等资料进行分析。另外,我们选择５０例无慢性肾病、ＶｉｔＤ缺乏、骨病等原因引起的钙磷失调者作为对照。结果正常人甲状旁腺显示率为２４０％（１２／５０）,尿毒症病人显示率为６０％（１８／３０）,而且,随着尿毒症血透时间的延长,肿大的甲状旁腺数目及大小均增加,增大体积与血清ＰＴＨ的增高呈正相关,但与血钙、血肌酐无明确关系。结论超声对尿毒症引起的继发性甲旁亢病人的甲状旁腺肿大检测有诊断价值,并能初步估计尿毒症血透时间长短及甲旁亢严重程度     

继发性甲状旁腺机能亢进的超声引导介入治疗与并发症

目的探讨经皮向增生的甲状旁腺内注入无水酒精(PEITP)治疗继发性甲状旁腺机能亢进(secondary hyperparathyroidism，SHPI)的常见并发症、相关因素及预防措施。方法分析比较35例经治疗患者的治疗方法、疗效与并发症发生情况。结果35例患者经治疗其血清全段甲状旁腺素(PTH)全部下降。缓解率17．1％(6／35)，显效率51．4％(18／35)，满意率28．6％(10／35)，无效率2．9％(1／35)。并发症10例，其中疼痛7例，出血3例，声音嘶哑2例。结论PEITP是治疗继发性甲旁亢的有效方法，严格掌握治疗适应症，提高穿刺技术。临床治疗的密切配合是避免并发症的有效措施。     

超声介入治疗在继发性甲状旁腺功能亢进中的应用

目的探讨高频彩超引导下介入治疗继发性甲状旁腺功能亢进的方法。方法观察、比较28例患者经超声引导无水酒精硬化治疗前后血清PTH水平的变化及甲状旁腺腺体内血流的变化，评价其治疗效果。结果28例患者经治疗后，其血清PTH全部明显下降，腺体内部血流信号明显减少。缓解率14．2％(4，28)，显效率57．1％(16／28)，满意率28．5％(8／28)。结论高频彩超引导下经皮注射无水酒精硬化治疗(PEIT)继发性甲状旁腺功能亢进是一种安全、有效的治疗方法，治疗过程快速、简洁。血清PTH和腺体内部血流信号的变化是观察疗效的重要指标。     

超声检查维持性血液透析患者继发性甲状旁腺功能亢进的临床价值

目的了解维持性血透患者继发性甲状旁腺功能亢进的超声表现，探讨彩色多普勒超声在继发性甲状旁腺功能亢进诊治中的临床价值。方法对39例维持性血液透析且在1个月内检查过血清PTH患者进行甲状旁腺的超声检查，发现病灶后记录其部位、大小、数目及声像图特点，血流供应情况。结果39例维持性血透患者中，增大甲状旁腺检出率19例SHP组为47．37％，20例非SHP组有3例（15％）。增大甲状旁腺超声表现为边界清晰类圆形均质低回声结节。SHP患者17个病灶有丰富血供。结论超声检查对继发性甲状旁腺功能亢进手术治疗有定位诊断的价值，可为选择超声引导下介入治疗提供影像依据。     

高频彩超在继发性甲旁亢诊断中的意义

目的 探讨继发性甲状旁腺机能亢进(简称继发甲状旁亢)的超声图象与其他颈部病变的区别。方法 比较继发甲旁亢与结节性甲状腺肿、淋巴结的超声图象。结果 53例终末期肾病合并继发甲旁亢患者中39例甲状旁腺增生;31例有结节性甲状腺肿,32例检出肿大淋巴结。结论 甲状旁腺增生、结节性甲状腺肿、颈部淋巴结的超声图象在形态、大小、内部回声及彩色血流等方面各有特点,运用超声技术可以进行鉴别诊断。     

Reversal of Secondary Hyperparathyroidism by Cimetidine in Chronically Uremic Dogs

Chronic cimetidine therapy has been shown to suppress circulating concentrations of immunoreactive parathyroid hormone (iPTH) in hemodialysis patients. To evaluate the long-term metabolic effects of cimetidine treatment, we studied seven chronically uremic dogs for 20 wk. The dogs were studied under metabolic conditions before, during, and after cimetidine therapy. iPTH fell progressively in the five treated dogs from 536±70 μleq/ml (mean±SE) (nl < 100 μleq/ml) before treatment to 291±25 μleq/ml at 12 wk (P < 0.001) and 157±32 μleq/ml at 20 wk (P < 0.001). The control dogs showed no consistent change in iPTH. The fall in iPTH was not associated with a change in serum ionized calcium. However, serum phosphorus decreased from 5.7±0.9 mg/dl to 3.4±0.2 mg/dl by the 20th wk (P < 0.05). By contrast, the serum concentration of 1,25-dihydroxycholecalciferol increased in all treated dogs from 33.4±4.3 pg/ml to 51.8±2.4 pg/ml during treatment (P < 0.01). Calcium balance was negative in all seven dogs before cimetidine (−347±84 mg/72 h) and remained so in the control dogs; it became positive in the five treated dogs after 12 wk (1,141±409 mg/72 h) (P < 0.05). Phosphorus balance, 24-h fractional phosphate excretion, and creatinine clearance remained unchanged. Pooled samples of serum obtained during the control and 20th wk of therapy were fractionated by gel filtration and the eluates assayed for immunoreactivity. The decrease in iPTH was associated with a decrease in all the immunoreactive species, indicating suppression of parathyroid gland secretion.     

肝移植术后腹腔积液的超声引导下治疗

目的：探讨超声介入法治疗肝移植术后腹腔积液的价值。方法：回顾分析在超声引导下穿刺或置管治疗20例肝移植术后腹腔积液的临床资料。结果：20例超声引导下治疗均获得成功,包括右膈下积液5例,肝肾区积液4例,肝门区积液4例,大量腹水7例,其中3例因分隔性积液而重新置管,置管后症状均有改善,未发生严重并发症。结论：超声介入法治疗肝移植术后腹腔积液安全、快捷、有效。     

子宫肌瘤的介入治疗

目的：研究超选择子宫肌瘤供血动脉栓塞治疗子宫肌瘤的临床疗效。材料与方法：对11例患者进行了双侧子宫肌瘤供血动脉的栓塞治疗。结果：11例插管栓塞成功率100％，随访1～6月。B超示：6月2例，肿块缩小90％。5月3例，肿块缩小70％，3月4例，肿块缩小60％，2月2例，肿块缩小40％，1月1例，肿块囊变，缩小20％。结论：子宫肌瘤的介入治疗是十分有效的，远期效果有待于进一步观察。     

Evidence for Secondary Hyperparathyroidism in Idiopathic Hypercalciuria

Circulating levels of immunoreactive parathyroid hormone (PTH) were measured in 40 patients with idiopathic hypercalciuria (IH) before and during reversal of hypercalciuria with thiazide, and in four normal subjects before and during induction of hypercalciuria with furosemide. 26 patients with IH had elevated serum PTH levels. The remaining patients had normal levels. Although the correlation was not complete, high PTH levels were generally found in patients who had more severe average urinary calcium losses. When initially elevated. PTH levels fell to normal or nearly normal values during periods of thiazide administration lasting up to 22 months. When initially normal, PTH levels were not altered by thiazide. Reversal of hyperparathyroidism by thiazide could not be ascribed to the induction of hypercalcemia, since serum calcium concentration failed to rise in a majority of patients. Renal hypercalciuria produced by furosemide administration elevated serum PTH to levels equivalent to those observed in patients with IH.The findings in this study help to distinguish between several current alternative views of IH and its relationship to hyperparathyroidism. Alimentary calcium hyperabsorption cannot be the major cause of IH with high PTH levels, because this mechanism could not elevate PTH. Idiopathic hypercalciuria cannot be a variety of primary hyperparathyroidism, as this disease is usually defined, because PTH levels are not elevated in all patients and, when high, are lowered by reversal of hypercalciuria. Primary renal loss of calcium could explain the variable occurrence of reversible hyperparathyroidism in IH, since renal hypercalciuria from furosemide elevates serum PTH in normal subjects. Consequently, a reasonable working hypothesis is that IH is often due to a primary renal defect of calcium handling that leads, by unknown pathways, to secondary hyperparathyroidism.     

罗氏内异方联合超声介入治疗复发性巧克力囊肿的临床研究

目的:探讨罗氏内异方联合超声介入治疗复发性巧克力囊肿的临床疗效。方法:将复发性巧克力囊肿患者随机分为两组,A组月经干净后3~7d行超声介入治疗,术后给予口服罗氏内异方30mL,tid,经期停服,共3个月。B组给予诺雷德3.6mg经皮下注射,每隔28d注射1次,共3次,作为对照。治疗后,观察两组患者痛经症状、囊肿大小和CA125变化情况及对血清E2及妊娠率的影响。结果:罗氏内异方联合超声介入治疗和诺雷德治疗复发性巧克力囊肿均能有效改善患者的临床症状、减少血清CA125水平及提高妊娠率,前者疗效更好,且可使血清E2保持在卵泡期水平。结论:罗氏内异方联合超声介入治疗复发性巧克力囊肿疗效优于诺雷德,副作用少、安全性高,患者易于接受,且不出现雌激素缺乏症状,有利于早日受孕。