新医学2017，Vol.48Issue(2)：128-131,4.DOI:10.3969/j.issn.0253-9802.2017.02.013
手术治疗透析患者继发性甲状旁腺功能亢进症的临床疗效--附45例分析
Clinical efficacy of parathyroidectomy in treating secondary hyperparathyroidism in dialysis patients:a analysis of 45 cases
梁伟 1李朋 1陈丽 1邹莎琳 1姜蕾1
作者信息
- 1. 518036 深圳，北京大学深圳医院肾内科，甲状腺外科
- 折叠
摘要
Abstract
Objective To evaluate the clinical efficacy and postoperative complications of parathy-roidectomy in the treatment of secondary hyperparathyroidism in patients receiving maintenance dialysis.Meth-ods Clinical data of 45 patients diagnosed with secondary hyperparathyroidism receiving maintenance dialysis were retrospectively analyzed.The changes in calcium,phosphorus,total parathormone,alkaline phosphatase and clinical symptoms were observed before and after parathyroidectomy.Surgical complications,recurrence of hyperparathyroidism and clinical prognosis were analyzed.Results Among 45 patients,39 underwent total parathyroidectomy combined with forearm auto-transplantation,and 6 received subtotal parathyroidectomy.Four parathyroid glands were resected in 42 patients,5 in 1 case and 3 in 2 patients.Nodular hyperplasia was ob-served in 45 cases.Five patients were complicated with parathyroid adenoma.After surgery,the levels of phos-phorus,parathormone and alkaline phosphatase in 45 patients were significantly declined (all P <0.01 25). Within 1 week after surgery,hypocalcemia was observed in 37 cases (82%).Intravenous administration of calcium was delivered for over 1 week in 34 cases,over 2 weeks in 9 patients and more than 1 month in 1 case. Intravenous administration of calcium was not given in 3 patients.Intraoperatively,2 cases (4%)presented with recurrent nerve injury.Within postoperative 1 week,3 patients (7%)suffered from lower limb fracture, 2 of them were recovered and 1 achieved poor healing.Two patients (4%)had incisional hematoma.Postoper-ative massive hematoma,apnea or death was not documented.Bone pain,joint pain and cutaneous pruritus in 44 patients were alleviated within postoperative 1 month.The bone pain in 1 case was mitigated at postoperative 1 year.Two patients (4%)presented with recurrent hyperparathyroidism.Conclusions Parathyroidectomy is an efficacious treatment of secondary hyperparathyroidism following maintenance dialysis.However,much at-tention should be diverted to the prevention and treatment of postoperative complications.关键词
维持性透析/继发性甲状旁腺功能亢进症/甲状旁腺切除术Key words
Maintenance dialysis/Secondary hyperparathyroidism/Parathyroidectomy引用本文复制引用
梁伟,李朋,陈丽,邹莎琳,姜蕾..手术治疗透析患者继发性甲状旁腺功能亢进症的临床疗效--附45例分析[J].新医学,2017,48(2):128-131,4.
