甲状旁腺全切除加前臂自体移植术治疗肾性继发性甲状旁腺功能亢进的长期疗效

目的: 探究甲状旁腺全切除加前臂自体移植术（total parathyroidectomy with forearm autotransplantation, TPTX+AT）治疗肾性继发性甲状旁腺功能亢进（secondary hyperparathyroidism, SHPT）术后长期疗效。方法: 我院1999年1月至2017年11月行TPTX+AT的SHPT病人124例,分析术后症状改善和血钙、磷、全段甲状旁腺激素（intact parathyroid hormones, iPTH）水平变化,以及术后复发率、持续性甲状旁腺功能低下发生率、死亡率等。结果: 术后病人临床症状均明显改善。术后1个月病人血钙、磷、iPTH及碱性磷酸酶水平均较术前明显降低（均P<0.05）,基本可长期控制在正常水平。随访至2018年5月,10例（8.06%）复发,7例（5.64%）发生持续性甲状旁腺功能低下,19例（15.32%）死亡。结论: TPTX+AT治疗SHPT能长期有效地缓解症状,改善钙磷代谢。术后复发率与持续性甲状旁腺功能低下发生率、死亡率均在较低水平。

Long-term outcome of total parathyroidectomy with autotransplantation in treatment of renal secondary hyperparathyroidism

Objective To explore the long-term outcome of total parathyroidectomy with forearm autotransplantation (TPTX+AT) in the treatment of patients with secondary hyperparathyroidism (SHPT) of renal disease. Methods A total of 124 patients with SHPT were subjected to TPTX+AT from January 1999 to November 2017 and were analyzed. The clinical data including symptom relief, calcium, phosphate and intact parathyroid hormone (iPTH) in serum before and after the surgery were collected. Recurrence rate, persistent hypoparathyroidism and mortality rate were analyzed. Results After operation, symptoms relieved significantly. Calcium, phosphate and iPTH in serum decreased significantly 1 month postoperative when compared those preoperative, and could be maintained well for a long period. It was shown that 10 patients(8.06%) had recurrence, 7 patients(5.64%) had persistent hypoparathyroidism and 19 patients (15.32%) died after follow-up until to May 2018. Conclusions TPTX+AT could be performed to treat patients with SHPT that relieves symptoms effectively and improves calcium and phosphorus metabolism for a long period. Recurrence rate, persistent hypoparathyroidism and mortality might be maintained at a lower level.