4例难治性继发性甲状旁腺功能亢进患者外科治疗后肾移植疗效观察

doi:10.6040/j.issn.1671-7554.0.2022.0819

摘要/Abstract

摘要： 目的分析难治性继发性甲状旁腺功能亢进(rSHPT)且有肾移植意愿患者行甲状旁腺切除术(PTx)的时机及手术方式对肾移植疗效的影响。方法回顾性分析2010年4月至2021年12月在解放军联勤保障部队第九六〇医院因rSHPT接受PTx且在术后进行肾移植的4例患者临床资料。采用Kruskal-Wallis检验比较两次手术前后各项指标变化。结果 PTx手术方式均为甲状旁腺全切+微量自体移植术(tPTX+AT),术后骨骼疼痛、皮肤瘙痒等临床症状均完全缓解,甲状旁腺激素(PTH)和血清磷回归正常范围。肾移植前1例患者血清钙恢复至正常水平,另3例患者血清钙略低于正常,肾移植后随访52(6~100)个月,移植肾功能稳定,估计肾小球滤过率(eGFR)由术前5.35(4.50~5.80)mL/min升至术后83.80(68.60~95.60)mL/min(P=0.021),期间均未出现移植肾功能不全或移植肾失功等并发症。结论对于rSHPT且有肾移植意愿的患者,应在肾移植前行甲状旁腺外科治疗,术式建议采用tPTX+AT。

关键词: 尿毒症, 继发性甲状旁腺功能亢进, 难治性, 肾移植, 甲状旁腺切除术

Abstract: Objective To analyze the timing of parathyroidectomy(PTx)in patients with refractory secondary hyperparathyroidism(rSHPT)willing to receive kidney transplantation and to explore the impact of surgery on kidney transplantation. Methods The clinical data of 4 patients who underwent PTx for rSHPT and then kidney transplantation(KTx)during Apr. 2010 and Dec. 2021 were retrospectively analyzed. The clinical parameters before and after the two surgeries were compared with Kruskal-Wallis test. Results All patients underwent total parathyroidectomy with auto-transplantation(tPTx+AT). After surgery, clinical symptoms such as skeletal pain and skin pruritus were completely relieved, and both parathyroid hormone(PTH)and serum phosphate returned normal. Before KTx, serum calcium returned to the normal level in one patient and slightly below normal in the other three patients. After KTx, during the follow-up of 52(6-100)months, the grafted kidney function was stable, estimated glomerular filtration rate(eGFR)increased from 5.35(4.50-5.80)(mL/min)preoperatively to 83.80(68.60-95.60)(mL/min)postoperatively(P=0.021), and no complications such as transplanted kidney insufficiency or graft dysfunction occurred. Conclusion For rSHPT patients willing to undergo kidney transplantation, total parathyroidectomy with auto-transplantation is suggested.

Key words: Uremia, Secondary hyperparathyroidism, Refractory, Kidney transplantation, Parathyroidectomy

中图分类号:

R582

郭浩男,贺青卿,周鹏,李小磊,庄晓璇,岳涛,高远,徐婧,邵长秀,李陈钰,庄大勇. 4例难治性继发性甲状旁腺功能亢进患者外科治疗后肾移植疗效观察[J]. 山东大学学报 (医学版), 2023, 61(1): 58-61.

GUO Haonan, HE Qingqing, ZHOU Peng, LI Xiaolei, ZHUANG Xiaoxuan, YUE Tao, GAO Yuan, XU Jing, SHAO Changxiu, LI Chenyu, ZHUANG Dayong. Outcomes of kidney transplantation after surgical treatment in 4 patients with refractory secondary hyperparathyroidism[J]. Journal of Shandong University (Health Sciences), 2023, 61(1): 58-61.

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