甲状旁腺次全切除术与亚次全切除术的疗效比较VIP专享VIP免费

中国血液净化2012年7月第ll卷第7期ChinJBloodPu域July'2012，VoLll，No．7甲状旁腺次全切除术与亚次全切除术的疗效比较陈浩雄刘日光李剑文陈林陈磊傅君舟●【摘要】目的比较甲状旁腺次全切除术与亚次全切除术治疗尿毒症继发性甲状旁腺功能亢进症(Secondaryhyperparathyroidism。SHPT)的临床疗效。方法回顾性分析在2007年7月至2011年5月期间在广州市第一人民医院进行甲状旁腺次全切除术的SHPT患者18例，根据切除范围不同分两组，亚次全切组切除4个腺体中的3个，共8例；次全切组：切除3．5个腺体，共10例。观察术前及术后I天、1周、1个月、6个月的数据，包括血钙(Ca)、血磷(P)、钙磷乘积(Ca×P)、血清全段甲状旁腺素(iPTH)、碱性磷酸酶(ALP)，以及临床症状的改善情况和相关并发症．比较两种手术的疗效。结果两组患者术前彩超发现的甲状旁腺结节数、Ca、P、Ca×P、iPTH、ALP全部无统计学意义。全部患者在1周内疼痛症状均明显缓解，两组缓解时间、手术并发症无统计学意义；术前和术后Ca、P、Ca×P、iPTH、ALP两组均明显下降(P<0．05)；两组间比较，Ca在术后1周、1个月，P和Ca×P在术后1周、1个月、6个月，iPTH在术后1天、1周、1个月、6个月，ALP在6个月，次全切组较亚次全切组均有显著下降(P<0．05)。结论甲状旁腺次全切除术是治疗尿毒症继发性甲状旁腺功能亢进的有效方法，但术式上次全切除术比亚次全切除术更能减少持续性和复发性SHPT。【关键词】甲状旁腺次全切除术；继发性甲状旁腺功能亢进症：维持性血液透析；持续性和复发性甲状旁腺功能亢进症中图分类号：R318．16文献标识码：Adoi：10．3969／j．i$sn．1671-4091．2012．07．006Comparisonsofthetherapeuticeffectsbetweenpatientswithsubtotalparathyroidectomyandthosewithless-thansubtomiparathyroidectomyCHENHao-xiong,LIURi-guang。L1Jian-wen．CHENLin,CHENLei,FUJun-zhou．DepartmentofNephrology,GuangzhouFirstMunicipalPeople0Hospital,Guangzhou510080,ChinaCorrespondingauthor-FUJun-zhou；e-mail：fuizhou@163Lcom[Abstract]ObjectiveTocomparetheefficacyofsubtotalparathyroidectomyandless—thansubtotalparathyroidectomyinuremicpatientswithsecondaryhyperparathyroidism(SHPT)．MethodsWeretrospectivelyanalyzedl8patientssubjectedtopammyroidectomyinthishospitalfromJuly2007toMay2011．Thepatientswereassignedintotwogroups：less-thansubtotalparathyroidectomygroup(n=8)，inwhich3ofthe4glandswereresectod,andsubtotalpamthyroidc：ctomygroup(n=10)，inwhich3andahalfofthe4glandsWereremoved．Serumcalcium(Ca)，phosphorus(P)，calcium-phosphorusproduct(Ca×P)，intactparathyroidhormone(iPTH)andalkalinephosphatase(ALP)，aswellaschangesofclinicalsymptomsandrelatedcomplicationswereobservedbeforeoperationandaftertheoperationforoneday，oneweek,onemonthand6monks．ResultsNostatisticaldiffereneeswcⅡ'efoundinnumberofparathyroidnodules，辩mmCa,P。Ca×P，iPTHandALPbeforeoperationbetweenthetwogroups．TherewerestatisticaldifferencesinCa，P'Ca×P'iPTHandALPbeforeandafteroperationineachgroup(P<0．05)．Insubtotalparathyroidectomygroup，scrun'lCaWaslowerafteroperationforoneweekandonemonth(尸<0．05)，PandCa×Pwe∞lowerafteroperationforoneweek,onemonthandsixmonths，iPTHwaslowerafteroperationforoneday，oneweek,onemonthandsixmortths．while札PwasIowerafteroperationforsixmonths，ascomparedWiththoseoftIleless-thansubtotalparathyroidectomygmup．Inbothgroups，painsymptomsrelievedafteroperationforoneweek。withoutdifferencesinrelieftimeandoperationcomplicationsbetweenthetWOgroups．ConclusionSubtotalparathyroidectomyismoreeffectivethanless-thansubtotalparathyroidectomyforthetreatmentofpersistent／recurrenthyperparathyroidism．【Keywords】Subtotalparathyroidectomy；Secondaryhyperparathyroidism；Maintenance...