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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

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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
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