腔镜下与开放手术治疗继发性甲状旁腺功能亢进的临床比较

目的:探讨腔镜下甲状旁腺全切(ETP)+部分甲状旁腺组织前臂移植(PTA)与开放甲状旁腺全切术(OP)+PTA治疗继发性甲状旁腺功能亢进(SHPT)的临床比较。方法:2009年4月—2012年6月22例SHPT患者经胸前路径行ETP,同时将16枚1 mm×1 mm×3 mm大小的增生甲状旁腺部分组织移植于患者前臂肱桡侧肌膜下。同期25例SHPT患者经颈部行OP+PTA。结果:22例ETP+PTA及25例OP+PTA均顺利完成,无术中及围手术期死亡。ETP+PTA患者手术时间、出血量、下床时间、住院时间较OP+PTA患者明显减少(P0.05),ETP+PTA组术中、术后并发症与OP+PTA组差异无统计学意义(P0.05),而术后临床症状均有明显改善,生化检查均恢复正常或明显改善,寻找甲状旁腺个数ETP+PTA组亦优于OP+PTA组(P0.05),随访6个月复发率差异无统计学意义(P0.05)。结论:ETP+PTA操作安全,寻找甲状旁腺更有优势,喉返神经的保护更好,出血量更少,同时具有美容效果,是对传统手术的改进和发展,值得推广。

Clinical comparison of laparoscopic and open operation for the treatment of secondary hyperparathyroidism

Objective：To campare the clinical effect between endoscopic total parathyroidectomy （ETP） with parathyroid tissue autotransplantation （PTA） and open parathyroidectomy（OP） with PTA in treating secondary hyperparathyroidism （SHPT）.Methods：22 SHPT patients were treated with the endoscopic thyroidectomy via anterior thoracic approach approachand implanted with 16 parts of proliferating parathyroid gland with the size 1 mm × 1 mm × 3 mm under the brachioradialis muscle membrane side,the another 25 SHPT patients were treated with OP＋PTA via neck from April 2009 to June 2012.Results：The 22 ETP＋PTA and 25 OP＋PTA operations were carried out successfullyand no die during perioperative period.The operation time,amount of bleeding in patients with ETP＋PTA than inpatients with reduced OP＋PTA,ETP＋PTA group operation,postoperative complications had no significant difference with OP＋PTA group,and the postoperative clinical symptoms were significantly improved,biochemical examination were normal or improved,ollow-up recurrence 6 months there was no significant difference.Conclusion：Treatment with EPT＋PTA is better than PTX （OP）＋PTA in SHPT patients.ETP＋PTA operation safety,looking for a better advantage of parathyroid,better protection of the recurrent laryngeal nerve,less blood loss.ETP combined with PTA is safe and effective,with less trauma,less pain,rapid recovery,also has a cosmetic effect,improvement and development of the traditional operation,worthy of promotion.