甲状旁腺全切加微量腺体自体移植术治疗109例肾性继发性甲状旁腺功能亢进的长期疗效

目的 分析甲状旁腺全切加微量腺体自体移植术(tPTx+AT)治疗持续血液透析肾性继发性甲状旁腺功能亢进症(SHPT)患者的长期疗效。 方法 回顾性分析2011年1月至2015年12月于解放军第九六〇医院甲状腺乳腺外科接受tPTx+AT的SHPT患者109例临床资料,随访患者术前及术后(1周、1、3、6年)全段甲状旁腺激素(iPTH)、血钙、血磷的变化情况,并采用健康调查简表(SF-36)评估SHPT患者术前术后长期(3、6年)生存质量,评价tPTx+AT的长期效果。 结果 手术成功率为87.16%(95/109),随访过程中8例患者失访,14例患者死亡,其中3年内死亡7例,3~6年内死亡7例,共87例患者完成术后6年随访。患者术后iPTH、血钙、血磷较术前均下降,生存质量评分均提高,差异有统计学意义(P<0.05)。随访患者术后3年复发率4.60%(4/87)、死亡率6.93%(7/101),术后6年复发率12.50%(10/80)、死亡率13.86%(14/101),持续性甲状旁腺功能亢进(PHPT)的发生率为6.93%(7/101),永久性甲状旁腺功能低下的发生率为1.98%(2/101)。9例持续状态或复发患者接受再次手术治疗。 结论 tPTx+AT治疗SHPT安全、有效,手术成功率高,能显著降低甲状旁腺激素(PTH)水平,改善钙磷代谢,提高患者生存质量,术后长期复发率及死亡率较低。

Long-term efficacy of total parathyroidectomy with trace parathyroid tissue autotransplantation in the treatment of 109 cases of renal secondary hyperparathyroidism

Objective To analyze the long-term efficacy of total parathyroidectomy with trace parathyroid tissue autotransplantation(tPTx+AT)for patients with renal secondary hyperparathyroidism(SHPT)undergoing continuous hemodialysis. Methods Clinical data of 109 SHPT patients who underwent tPTx+AT during Jan. 2011 and Dec. 2015 were retrospectively analyzed. The changes of intact parathyroid hormone(iPTH), serum calcium and serum phosphorus before and after operation(1 week, 1 year, 3 years, 6 years)were collected. The long-term quality of life before and after operation(3 years, 6 years)were evaluated with the MOS 36-Item Short-Form Health Survey(SF-36). Results The success rate of operation was 87.16%(95/109). During the follow-up, 8 patients were lost; 14 patients died, including 7 deaths within 3 years and 7 within 3-6 years; 87 completed the follow-up for 6 years. The levels of iPTH, serum calcium and phosphorus significantly decreased after operation, and the score of quality of life significantly increased(P<0.05). The 3-year recurrence rate and mortality rate were 4.60%(4/87)and 6.93%(7/101), respectively, while the 6-year recurrence rate and mortality rate were 12.50%(10/80)and 13.86%(14/101), respectively. The incidence of persistent hyperparathyroidism(PHPT)and permanent hypoparathyroidism was 6.93%(7/101)and 1.98%(2/101), respectively. Nine patients with persistent or recurrent hyperparathyroidism underwent a second surgery. Conclusions tPTx+AT is safe and effective in the treatment of SHPT, with a high success rate of operation. It can significantly reduce the level of parathyroid hormone(PTH), improve calcium and phosphorus metabolism, enhance patients quality of life, and maintain a low long-term recurrence rate and mortality rate.