超声引导下射频消融治疗难治性继发性甲旁亢的临床研究

目的:探究难治性继发性甲旁亢(Secondary hyperparathyroidism,SHPT)治疗中超声引导下射频消融(Radiofrequency ablation,RFA)的临床治疗效果。方法:本试验选取2016年12月~2018年12月中山市中医院收治的50例难治性SHPT患者为观察对象,将其分为完全消融组25例,不完全消融组25例。完全消融组将超声所能见到的甲状旁腺组织进行完全消融,不完全消融组依据"四留一,三留半"原则进行治疗。比较两组治疗前后的即刻、1天、1周、1个月、3个月、6个月及1年的血清甲状旁激素(PTH)、血钙(Ca)和血磷(P)的浓度。结果:完全消融组和不完全消融组在各个时间点上的血PTH浓度有统计学差异(P<0.05)。完全消融组和不完全消融组治疗1天、1周、1个月、3个月、6个月及1年的血PTH浓度均低于即刻时的血PTH浓度(P<0.05)。完全消融组和不完全消融组在不同时间点上的血Ca浓度有统计学差异(P<0.05)。在1周、1个月、3个月、6个月及1年时间点上,其与即刻时间点的的血Ca浓度有统计学差异(P<0.05)。完全消融组和不完全消融组在各个时间点上的血P浓度有统计学差异(P<0.05)。完全消融组和不完全消融组治疗1个月、3个月、6个月及1年的血PTH浓度均低于即刻时的血P浓度(P<0.05)。结论:在对难治性SHPT患者开展治疗的过程中,完全消融方式的临床效果更加显著,值得在临床中应用和并推广。

Clinical Research on Refractory Secondary Parathyroidism Treated by Ultrasound-Guided Radiofrequency Ablation

Purpose:To investigate the clinical efficacy of Radiofrequency ablation(RFA)in Secondary hyperparathyroidism(SHPT).Methods:this study selected 50 patients with refractory SHPT admitted to zhongshan hospital of traditional Chinese medicine from December 2016 to December 2018 as observation objects,and divided them into 25 cases of complete ablation group and 25 cases of incomplete ablation group.The parathyroid tissue visible by ultrasound was completely ablated in the complete ablation group,while the incomplete ablation group was treated according to the principle of"four stays for one,three stays for half".Serum parathyroid hormone(PTH),serum calcium(Ca)and serum phosphorus(P)concentrations were compared immediately,1 day,1 week,1 month,3 months,6 months and 1 year before and after treatment in the two groups.Results:there was no statistically significant difference in blood PTH concentration between the complete ablation group and the incomplete ablation group at each time point(P<0.05).The blood PTH concentrations of the complete ablation group and the incomplete ablation group on 1 day,1 week,1 mouth,3 mouths,6 mouths and 1 year were all lower than the immediate blood PTH concentrations(P<0.05).There were statistically significant differences in blood Ca concentrations between the complete ablation group and the incomplete ablation group at different time points(P<0.05).At the time points of 1 week,1 mouth,3 mouths,6 mouths and 1 year,the blood Ca concentration was statistically different from that at the immediate time point(P<0.05).There was a statistically significant difference in blood P concentration between the complete ablation group and the incomplete ablation group at each time point(P<0.05).The blood PTH concentrations of 1 mouth,3 mouths,6 mouths and 1 year in the complete ablation group and the incomplete ablation group were all lower than the immediate P concentrations(P<0.05).Conclusion:in the treatment of refractory SHPT patients,complete ablation has better clinical effect and is worthy of clinical application and promotion.