您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2023, Vol. 61 ›› Issue (4): 42-48.doi: 10.6040/j.issn.1671-7554.0.2022.1417

• 临床医学 • 上一篇    

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

邵长秀1,2,贺青卿2,庄晓璇3,周鹏2,李小磊2,岳涛2,徐婧2,李陈钰1,2,郭浩男1,2,庄大勇2   

  1. 1.锦州医科大学中国人民解放军联勤保障部队第九六〇医院研究生培养基地, 山东 济南 250031;2.中国人民解放军联勤保障部队第九六〇医院甲状腺乳腺外科, 山东 济南 250031;3.重庆医科大学国际医学院, 重庆 400016
  • 发布日期:2023-04-11
  • 通讯作者: 庄大勇. E-mail:zdyddy2000@TOM.com
  • 基金资助:
    中国人民解放军联勤保障部队第九六〇医院院长基金资助项目(2018ZX01)

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

SHAO Changxiu1,2, HE Qingqing2, ZHANG Xiaoxuan3, ZHOU Peng2, LI Xiaolei2, YUE Tao2, XU Jing2, LI Chenyu1,2, GUO Haonan1,2, ZHUANG Dayong2   

  1. 1. Postgraduate Training Base, The 960th Hospital of PLA Joint Logistics Support Force of Jinzhou Medical University, Jinan 250031, Shandong, China;
    2. Department of Thyroid Gland Breast Surgery, The 960th Hospital of PLA Joint Logistics Support Force of Jinzhou Medical University, Jinan 250031, Shandong, China;
    3. International Medical College of Chongqing Medical University, Chongqing 400016, China
  • Published:2023-04-11

PDF (PC)

428

摘要： 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。

关键词: 继发性甲状旁腺功能亢进症, 甲状旁腺全切除术, 自体移植术, 慢性肾脏病, 长期疗效

Abstract: 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.

Key words: Secondary hyperparathyroidism, Total parathyroidectomy, Autotransplantation, Chronic kidney disease, Long-term efficacy

中图分类号: 

  • R736.2
[1] Ene-Iordache B, Perico N, Bikbov B, et al. Chronic kidney disease and cardiovascular risk in six regions of the world(ISN-KDDC): a cross-sectional study [J]. Lancet Glob Health, 2016, 4(5): e307-e319.
[2] Lins L, Carvalho FM. SF-36 total score as a single measure of health-related quality of life: Scoping review [J]. SAGE Open Med, 2016, 4: 2050312116671725. doi: 10.1177/2050312116671725.
[3] 中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 慢性肾脏病继发甲状旁腺功能亢进外科临床实践中国专家共识(2021版)[J].中国实用外科杂志, 2021, 41(8): 841-848.
[4] Chávez KV, Márquez-González H, Chavez-Tostado M. The usefulness of intraoperative PTH as a predictor for successful parathyroidectomy in secondary hyperparathyroidism [J]. Front Surg, 2021, 8: 696469. doi: 10.1177/2050312116671725.
[5] Zhang L, Xing C, Shen C, et al. Diagnostic accuracy study of intraoperative and perioperative serum intact PTH level for successful parathyroidectomy in 501 secondary hyperparathyroidism patients [J]. Sci Rep, 2016, 6: 26841. doi:10.1038/srep26841.
[6] Schneider R, Slater EP, Karakas E, et al. Initial parathyroid surgery in 606 patients with renal hyperparathyroidism [J]. World J Surg, 2012, 36(2): 318-326. doi: 10.1007/s00268-011-1392-0.
[7] Orloff LA, Wiseman SM, Bernet VJ, et al. American thyroid association statement on postoperative hypoparathyroidism: diagnosis, prevention, and management in adults [J]. Thyroid, 2018, 28(7): 830-841.
[8] GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017 [J]. Lancet, 2020, 395(10225): 709-733.
[9] 于悦, 吴耀华. 继发性甲状旁腺功能亢进症外科治疗现状[J]. 国际外科学杂志, 2022, 49(2): 117-121. YU Yue, WU Yaohua. Current status of surgical treatment of secondary hyperparathyroidism [J]. International Journal of Surgery, 2022, 49(2): 117-121.
[10] Lau WL, Obi Y, Kalantar-Zadeh K, et al. Parathyroidectomy in the management of secondary hyperparathyroidism [J]. Clin J Am Soc Nephrol, 2018, 13(6): 952-961.
[11] 魏常胜, 骆成玉, 王以新, 等. 甲状旁腺全切除术治疗肾性继发性甲状旁腺功能亢进症近期疗效观察[J]. 中华实用诊断与治疗杂志, 2022, 36(5): 471-474. WEI Changsheng, LUO Chengyu, WANG Yixin, et al. Short-term effect of parathyroidectomy on renal secondary hyperparathyroidism [J]. Journal of Chinese Practical Diagnosis and Therapy, 2022, 36(5): 471-474.
[12] 施丹丽, 樊强, 王守练, 等. 甲状旁腺全切术对血液透析患者继发性甲状旁腺功能亢进症的疗效观察[J]. 兰州大学学报(医学版), 2021, 47(2): 76-80. SHI Danli, FAN Qiang, WANG Shoulian, et al. Observation of the effect of total parathyroidectomy on secondary hyperparathyroidism in patients under hemodialysis [J]. Journal of Lanzhou University(Medical Sciences), 2021, 47(2): 76-80.
[13] 王海峰, 张凌, 姚力, 等. 三种不同甲状旁腺切除术治疗继发性甲状旁腺功能亢进425例疗效比较[J]. 中国血液净化, 2016, 15(9): 455-458. WANG Haifeng, ZHANG Ling, YAO Li, et al. Efficacy comparison of the three parathyroidectomy methods in 425 patients with secondary hyperparathyroidism [J]. Chinese Journal of Blood Purification, 2016, 15(9): 455-458.
[14] 陈安举, 王田田, 薄少军, 等. 术中甲状旁腺激素测定在继发性甲状旁腺功能亢进手术中的临床应用价值[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(12): 1168-1172. CHEN Anju, WANG Tiantian, BO Shaojun, et al. Clinical application value of intraoperative parathyroid hormone determination in secondary hyperparathyroidism surgery [J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2019, 33(12): 1168-1172.
[15] Mizobuchi M, Ogata H, Koiwa F. Secondary hyperparathyroidism: pathogenesis and latest treatment [J]. Ther Apher Dial, 2019, 23(4): 309-318.
[16] 侯爱珍, 张剑利, 周余, 等. 甲状旁腺切除对尿毒症继发性甲状旁腺机能亢进症患者生活质量的影响[J]. 国际移植与血液净化杂志, 2019, 17(6): 16-20. HOU Aizhen, ZHANG Jianli, ZHOU Yu, et al. Effect of parathyroidectomy resection on the quality of life of hemodialysis patients with secondary hyperparathyroidism [J]. International Journal of Transplantation and Hemopurification, 2019, 17(6): 16-20.
[17] 丁蓉, 童宗武, 卢永新, 等. 甲状旁腺切除术和药物治疗继发性甲状旁腺功能亢进中的疗效与成本效果分析比较[J]. 中国血液净化, 2022, 21(4): 240-243. DING Rong, TONG Zongwu, LU Yongxin, et al. Efficacy and cost-effectiveness analyses of hyperparathyroidism treated with parathyroidectomy or drugs in secondary hyperparathyroidism patients [J]. Chinese Journal of Blood Purification, 2022, 21(4): 240-243.
[18] Liu ME, Qiu NC, Zha SL, et al. To assess the effects of parathyroidectomy(TPTX versus TPTX+AT)for Secondary Hyperparathyroidism in chronic renal failure: a systematic review and meta-analysis [J]. Int J Surg, 2017, 44: 353-362. doi: 10.1016/j.ijsu.2017.06.029.
[19] Yuan Q, Liao Y, Zhou R, et al. Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: an updated systematic review and meta-analysis [J]. Langenbecks Arch Surg, 2019, 404(6): 669-679.
[20] 吕凛生, 李少敏, 叶玉球, 等. 不同术式治疗继发性甲状旁腺功能亢进临床疗效的Meta分析[J]. 中华肾脏病杂志, 2019, 35(12): 914-921. LYU Linsheng, LI Shaomin, YE Yuqiu, et al. Effect of different surgical procedures of parathyroidectomy on secondary hyperparathyroidism: a meta-analysis [J]. Chinese Journal of Nephrology, 2019, 35(12): 914-921.
[21] Hou J, Shan H, Zhang Y, et al. Network meta-analysis of surgical treatment for secondary hyperparathyroidism [J]. Am J Otolaryngol, 2020, 41(2): 102370.
[22] Isaksson E, Ivarsson K, Akaberi S, et al. Total versus subtotal parathyroidectomy for secondary hyperparathyroidism [J]. Surgery, 2019, 165(1): 142-150.
[23] Sari R, Yabanoglu H, Hargura AS, et al. Outcomes of total parathyroidectomy with auto transplantation versus subtotal parathyroidectomy techniques for secondary hyperparathyroidism in chronic renal failure [J]. J Coll Physicians Surg Pak, 2020, 30(1): 18-22.
[24] 王红鹰, 黄骏文, 邹强, 等. 甲状旁腺全切除加前臂自体移植术治疗肾性继发性甲状旁腺功能亢进的长期疗效[J]. 外科理论与实践, 2018, 23(6): 523-527. WANG Hongying, HUANG Junwen, ZOU Qiang, et al. Long-term effect of total parathyroidectomy plus forearm autotransplantation on renal secondary hyperparathyroidism [J]. Journal of Surgery Concepts & Practice, 2018, 23(6): 523-527.
[25] Kidney Disease: Improving Global Outcomes(KDIGO)CKD-MBD Update Work Group. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder(CKD-MBD)[J]. Kidney Int Suppl, 2017, 7(1): 1-59.
[26] 乔楠, 付庆锋, 李鸿博, 等. 继发性甲状旁腺功能亢进外科治疗中甲状旁腺自体移植现状[J]. 中国实用外科杂志, 2019, 39(4): 379-381. QIAO Nan, FU Qingfeng, LI Hongbo, et al. Current situation of parathyroid autotransplantation in surgical treatment of secondary hyperparathyroidism [J]. Chinese Journal of Practical Surgery, 2019, 39(4): 379-381.
[27] Zhu L, Cheng F, Zhu X, et al. Safety and effectiveness of reoperation for persistent or recurrent drug refractory secondary hyperparathyroidism [J]. Gland Surg, 2020, 9(2): 401-408.
[28] Reitz RJ 3rd, Dreimiller A, Khil A, et al. Ectopic and supernumerary parathyroid glands in patients with refractory renal hyperparathyroidism [J]. Surgery, 2021, 169(3): 513-518.
[29] 徐婧, 田军, 庄大勇, 等. 99m锝-甲氧基异丁基异腈SPECT/CT联合超声对继发性甲状旁腺功能亢进手术前的定位诊断价值[J]. 中国血液净化, 2022, 21(1): 29-32. XU Jing, TIAN Jun, ZHUANG Dayong, et al. Value of 99mTc-MIBI SPECT/CT combined with ultrasonography in preoperative localization of parathyroid glands in secondary hyperparathyroidism [J]. Chinese Journal of Blood Purification, 2022, 21(1): 29-32.
[30] 张勇, 邱传亚, 徐先发, 等. 多种影像学方法术前诊断继发性甲状旁腺功能亢进症增生结节[J]. 中国医学影像技术, 2021, 37(2): 206-210. ZHANG Yong, QIU Chuanya, XU Xianfa, et al. Multiple imaging methods in preoperative diagnosis of hyperplastic nodules in secondary hyperparathyroidism [J]. Chinese Journal of Medical Imaging Technology, 2021, 37(2): 206-210.
[31] 陈则君, 薛勤, 黄钱焕, 等. 99 mTc-MIBI SPECT/CT显像联合超声对继发性甲状旁腺功能亢进症患者甲状腺内异位甲状旁腺的术前定位[J]. 中华骨质疏松和骨矿盐疾病杂志, 2020, 13(2): 126-132. CHEN Zejun, XUE Qin, HUANG Qianhuan, et al. Preoperative localization of ectopic intrathyroid parathyroid gland by 99m Tc-MIBI SPECT/CT and ultrasonography for patients with secondary hyperparathyroidism [J]. Chinese Journal of Osteoporosis and Bone Mineral Research, 2020, 13(2): 126-132.
[32] Lim CTS, Kalaiselvam T, Kitan N, et al. Clinical course after parathyroidectomy in adults with end-stage renal disease on maintenance dialysis [J]. Clin Kidney J, 2018, 11(2): 265-269.
[33] Komaba H, Taniguchi M, Wada A, et al. Parathyroidectomy and survival among Japanese hemodialysis patients with secondary hyperparathyroidism [J]. Kidney Int, 2015, 88(2): 350-359.
[34] 胡药药, 李恩就, 王兴. 甲状旁腺全切除加前臂自体移植术对继发性甲状旁腺功能亢进症患者心脏功能的影响[J]. 广州医药, 2020, 51(1): 113-116. HU Yaoyao, LI Enjiu, WANG Xing. Effect of total parathyroidectomy plus forearm autotransplantation on cardiac function in patients with secondary hyperparathyroidism [J]. Library Work and Study, 2020, 51(1): 113-116.
[35] Iwamoto N, Sato N, Nishida M, et al. Low parathyroid hormone levels after parathyroidectomy reduce cardiovascular mortality in chronic hemodialysis patients [J]. Clin Exp Nephrol, 2016, 20(5): 808-814.
[1] 吕晨箫,李洋,高颖,张群业,张磊,王尊松. 慢性肾脏病5期患者的肠道菌群变化[J]. 山东大学学报 (医学版), 2019, 57(7): 72-79.
[2] 周苗,卞伟玮,柳晓涓,康凤玲,薛付忠,刘静. 嗜碱性粒细胞百分比与慢性肾脏病关系的回顾性队列研究[J]. 山东大学学报 (医学版), 2018, 56(3): 85-90.
[3] 周苗,夏同耀,孙爱玲,李明,申振伟,卞伟玮,蒋正,康凤玲,柳晓涓,薛付忠,刘静. 健康管理人群慢性肾脏病风险预测模型[J]. 山东大学学报（医学版）, 2017, 55(6): 98-103.
[4] 申振伟,季晓康,王庆莲,李洁,薛付忠,刘静. 非酒精性脂肪肝与慢性肾脏病关系的回顾性队列研究[J]. 山东大学学报（医学版）, 2016, 54(7): 43-49.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发