继发性肾源性异位甲状旁腺功能亢进的介入栓塞治疗

目的探讨介入栓塞治疗继发性肾源性异位甲状旁腺功能亢进的有效性、安全性及可行性。 方法术前通过高频超声、^99mTc-MIBI甲状旁腺核素显像、增强CT或增强MRI检查评估异位甲状旁腺的解剖位置及动脉血供情况，采用介入栓塞的方式阻断其供血动脉，从而使其逐渐缺血坏死失去功能。 结果第1例患者的异位甲状旁腺通过介入栓塞治疗后，其甲状旁腺素（parathyroid hormone，PTH）水平迅速下降，血钙、血磷亦迅速下降，皮肤瘙痒、周身骨痛等临床症状明显缓解；第2例患者因供血动脉显示不清，加之术中难以配合，仅完成部分血管栓塞，其PTH、血钙、血磷等指标呈一过性下降，但最终疗效不佳。 结论介入栓塞治疗异位甲状旁腺是一种创伤小、操作简便、疗效相对可靠、安全性高的方法，成功的关键是术前明确定位及供血动脉，术中尽量完全栓塞其供血动脉，但其长期有效性尚需进一步评价。

Interventional embolization of secondary nephrogenic ectopic hyperparathyroidism

ObjectiveTo investigate the efficacy, safety and feasibility of interventional embolization in the treatment of secondary nephrogenic ectopic hyperparathyroidism. MethodsThe anatomic location and arterial blood supply of ectopic parathyroid gland were evaluated by high frequency ultrasound, 99mTc-MIBI parathyroid radionuclide imaging, enhanced CT or enhanced MRI before operation, and the supplying artery was blocked by interventional embolization, resulting in gradual ischemic necrosis and loss of function. ResultsAfter interventional embolization, the level of parathyroid hormone (PTH) decreased rapidly, the serum calcium and phosphorus also decreased rapidly, and the clinical symptoms such as skin pruritus and general bone pain were obviously relieved in one case.In another case, because of the blood supply artery was not clear and it was difficult to cooperate during the operation, only part of the vascular embolization was completed, and the indexes such as PTH, serum calcium and phosphorus decreased temporarily, but the final effect was not good. ConclusionsInterventional embolization for the treatment of ectopic parathyroid is a minimally invasive, simple, reliable and safe method. The key to success is to clear the anatomic location and arterial blood supply of ectopic parathyroid gland before operation and to completely embolize the blood supply during operation, but its long-term effectiveness needs further evaluation.