甲状旁腺次全切除术治疗尿毒症继发性甲状旁腺功能亢进的疗效观察

目的研究甲状旁腺次全切除术对尿毒症维持性血液透析继发性甲状旁腺功能亢进（secondary hyperparathyroidism，SHPT）患者的临床疗效。方法对2006年6月至2011年6月在江西省赣州市人民医院接受甲状旁腺次全切除术治疗的尿毒症维持性血液透析SHPT10例行回顾性分析，对术前及术后1周、1个月、3个月、6个月的全段甲状旁腺激素（iPTH）、血钙、血磷及钙磷乘积行统计学分析，统计术前及术后骨关节痛缓解情况及手术并发症。结果①10例手术均成功，术中甲状旁腺位置与术前B超定位一致，术后均未出现明显并发症；②患者术后骨关节疼痛明显缓解，瘙痒感明显减轻；③术后1周、1个月、3个月、6个月的iPTH、血钙、血磷及钙磷乘积较术前明显下降（P〈0．05），差异有统计学意义。结论术前颈部甲状旁腺B超定位指导手术是可行的方法。甲状旁腺次全切除术能有效治疗尿毒症维持性血液透析SHPT患者，手术安全，治疗效果满意。

Effect of subtotal parathyroidectomy on secondary hyperparathyroidism in uremic patients

Objective To study the clinical effect of subtotal parathyroidectomy on secondary hyperparathyroidism（SHPT） in uremic patients undergoing hemodialysis. Methods The data of 10 uremic patients undergoing hemodialysis who received subtotal parathyroidectomy from Jun. 2006 to Jun. 2011 in our hospital were retrospectively analyzed. Intact parathyroid hormone （iPTH） , serum calcium, phosphorus and calcium-phosphorus product were analyzed statistically before operation, 1 week, 1 month, 3 months, and 6 months after the operation. The joint pain relief and postoperative complications were studied. Results （1）All of the 10 patients were successfully operated. No complication occurred. The intraoperative site of the parathyroid was consistent with that positioned by the preoperative B ultrasound guidance. （2）Postoperative bone pain and pruritus were obviously relieved. （3）iPTH decreased significantly at 1 week, 1 month, 3 months, 6 months after surgery compared with that before surgery. The difference had statistical siguificance（P 〈0. 05）. （4）Postoperative serum calcium, serum phosphorus and calcium-phosphorus product decreased significantly at 1 week, 1 month, 3 months, 6 months after surgery compared with that before surgery. The difference had statistical significance （ P 〈 0.05 ）. Conclusions Preoperative localization for neck parathyroid by ultrasound scan is feasible. Subtotal parathyroidectomy can be effective in treatment of SHPT in uremic patients. The surgery were safe and with satisfactory treatment outcome.