甲状旁腺切除术对尿毒症患者难治性继发性甲旁亢的疗效观察

目的回顾性统计尿毒症难治性继发性甲状旁腺功能亢进患者进行甲状旁腺切除术的临床疗效。方法监测并统计12例人组患者术前及术后1个月、3个月、半年、1年的血钙、磷、全段甲状旁腺素及临床症状。结果全切＋自体移植7例，次全切5例。次全切患者均复发，改用药物保守治疗仍部分有效。全切＋自体移植中5例术后1年持续低全段甲状旁腺素，为（61．31±21．11）pg／ml（38～89．91pg／ml）。常见足跟疼痛以及下肢承重关节相关的临床表现。术后无论何种术式及是否复发，患者除不宁腿综合征以外的症状均改善或明显改善，且其3个月、6个月及1年时症状及生化指标均较术前有明显改变。结论手术能明显缓解难治性患者的症状及生化水平，但长期来看存在可能复发及长期低全段甲状旁腺素的问题。

Therapeutic evaluation of parathyroidectomy for refractory secondary hyperthyroidism

Objective To observe the clinical effect of parathyroidectomy （PTX） for refractory secondary hyperthyroidism（SHPT） patient with end-stage renal disease（ESRD）. Methods Twelve refractory SHPT patients were chosen. Their serum calcium, phosphorus and iPTH as well we their clinical manifestations before and 1 month,3 month,6 month and 1 year after operation were observed and compared. Results Of 12 cases, 7 cases received PTX ＋ parathyroid autotransplantation, and 5 cases received subtotal PTX（SPTX）. All of the 5 patients receiving S-PTX had recurrence, and some of them responded to the medical therapy after the relapse. Five out of the 7 PTX ＋ AT patients had persistent low iPTH level（61.31 -21.11）pg/ml （38～89. 91）]. Most common clinical manifestations of SHPT were heel pain and symptoms related to lower limb weight-bearing joints. No matter which surgery type was selected, and no matter the patients relapsed, the clinical manifestations were significantly alleviated after PTX except restless leg syndrome, as well as the laboratory values 3 months, 6 months and 1 year after operation. Conclusions PTX is an effective treatment for refractory SHPT patients, which can significantly alleviate the clinical manifestations and laboratory values. But relapse and persistent low iPTH may be the problem of PTX.