甲状旁腺次全切除术和甲状旁腺全切除加甲状旁腺自体移植术治疗尿毒症后继发性甲状旁腺功能亢进的疗效

目的 比较尿毒症后继发性甲状旁腺功能亢进（SHPT）行甲状旁腺次全切除术（sPTX）和甲状旁腺全切除（tPTX）加甲状旁腺自体移植（AT）术的疗效。方法 回顾性分析2005年2月至2012年9月期间中国人民武装警察部队新疆生产建设兵团指挥部后勤部医院及新疆维吾尔自治区人民医院行tPTX＋AT （n=57）和sPTX （n=19） 的76例尿毒症后SHPT患者的临床资料，比较2种术式的疗效。结果 76例患者手术成功68例（89.5%），切除不足8例（10.5%）。76例患者术后骨痛均缓解，皮肤瘙痒症状改善14例（26.9%，14/52）。tPTX＋AT组术后1 d、7 d及6个月的血钙水平均较低（P＜0.05），术后6个月的iPTH水平较低（P＜0.05）。2组患者的手术时间、术中出血量、住院时间及住院费用比较差异均有统计学意义，tPTX＋AT组均较长或较高（P＜0.05）。术后76例患者均获访，随访时间为6～18个月，中位数为8.7个月。其中tPTX＋AT组死亡2例，复发2例；sPTX组死亡1例，复发7例。sPTX组的复发率较高（P＜0.05）。结论 尿毒症后SHPT行tPTX＋AT的术后1年内复发率较低，行sPTX者更易发生术后复发；但tPTX＋AT组的手术时间、术中出血量、住院时间及住院费用更高（更长或更多）。 2种术式各有优劣，术式选择时需根据情况综合判定。

Efficacy of Subtotal Parathyroidectomy and Total Parathyroidectomy Plus Parathyroid Autotransplantation in Treatment of Secondary Hyperparathyroidism

Objective To compare the efficacy of subtotal parathyroidectomy （sPTX） and total parathyroidectomy （tPTX） plus parathyroid autotransplantation （AT） in treatment of secondary hyperparathyroidism （SHPT）. Methods Clinical data of 76 cases of uremia SHPT who underwent sPTX （n=19） and tPTX＋AT （n=57） in Xinjiang Armed Police Corps Command Military Hospital and The Xinjiang Uygur Autonomous Region People’s Hospital were retrospectively analyzed （from Feb. 2005 to Sep. 2012）. Results Of the 76 cases, 68 cases （89.5%） got successful surgery and 8 cases （10.5%） suffered non-complete resection, all cases had relief on bone pain, and 14 cases had relief on pruritus （26.9%, 14/52）. The values of serum calcium on 1 day, 7 days, and 6 months after operation were lower in tPTX＋AT group （P〈0.05）, and value of iPTH in 6 months after operation was lower too （P〈0.05）. The operation time, blood loss, hospital stay, and hospital cost in tPTX＋AT group were all higher or longer （P〈0.05）. All of the 76 cases were followed up for 6-18 months （the median time was 8.7 months）. During the followed-up, 2 cases died and 2 cases recurred in tPTX＋AT group, 1 case died and 7 cases recurred in sPTX group, that the recurrence rate was higher in sPTX group （P〈0.05）. Conclusion tPTX＋AT has lower recurrence rate, but with longer operation time and hospital stay, more blood loss, and expensive cost, so the choice of surgery for SHPT should be based on the comprehensive situation.