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外科治疗慢性肾病透析后难治性继发性甲状旁腺亢进的病例系列报道
Surgical treatment for refractory secondary hyperparathyroidism in chronic kidney disease patients after dialysis: a case series report series of 120 cases
- 陆军军医大学学报 2022年44卷第24期 页码：2530-2536
- 作者机构：
1.400038 重庆，陆军军医大学(第三军医大学)第一附属医院：超声科
2.400038 重庆，陆军军医大学(第三军医大学)第一附属医院：乳腺甲状腺外科
3.400038 重庆，陆军军医大学(第三军医大学)第一附属医院：核医学科
4.400038 重庆，陆军军医大学(第三军医大学)第一附属医院：肾内科
- 作者简介：
[任林，E-mail：61465508@qq.com REN Lin, E-mail: 61465508@qq.com
- 基金信息：重庆市社会民生科技创新专项课题资助(cstc2019jscx-msxmX0181)
DOI：10.16016/j.2097-0927.202208102
中图分类号： R582.1;R653;R692.06收稿：2022-08-15，
修回：2022-08-28，
纸质出版：2022-12-30
- 稿件说明：
移动端阅览
何芸, 程一帆, 田浩, 等. 外科治疗慢性肾病透析后难治性继发性甲状旁腺亢进的病例系列报道[J]. 陆军军医大学学报, 2022,44(24):2530-2536.
Yun HE, Yifan CHENG, Hao TIAN, et al. Surgical treatment for refractory secondary hyperparathyroidism in chronic kidney disease patients after dialysis: a case series report series of 120 cases[J]. Journal of Army Medical University, 2022, 44(24): 2530-2536.
何芸, 程一帆, 田浩, 等. 外科治疗慢性肾病透析后难治性继发性甲状旁腺亢进的病例系列报道[J]. 陆军军医大学学报, 2022,44(24):2530-2536. DOI： 10.16016/j.2097-0927.202208102.
Yun HE, Yifan CHENG, Hao TIAN, et al. Surgical treatment for refractory secondary hyperparathyroidism in chronic kidney disease patients after dialysis: a case series report series of 120 cases[J]. Journal of Army Medical University, 2022, 44(24): 2530-2536. DOI： 10.16016/j.2097-0927.202208102.
摘要
目的
2
总结慢性肾脏病(chronic kidney disease，CKD)透析后难治性继发性甲状旁腺亢进(secondary hyperparathyroidism，SHPT)的临床特征及外科治疗效果。
方法
2
回顾2018年1月至2019年12月间在我科接受手术治疗的102例CKD透析后难治性SHPT患者的治疗过程，分析血液学指标等临床特征，总结治疗效果和并发症发生情况。
结果
2
本研究中术后第一天PTH降低幅度均超过术前甲状旁腺激素(parathyroid hormone，PTH)水平的80%。术后第一天、第七天、术后3个月血钙、血磷和PTH均较术前明显降低，术中共切除甲状腺4例，清扫中央区淋巴结20例，切除胸腺10例。围手术期有15例患者出现手足口周麻木，其中2例出现了上肢远端抽搐，术后1周内99例患者的全身症状明显缓解。术后共发生5例永久性甲旁减、2例复发性SHPT。
结论
2
外科手术是难治性SHTP的有效治疗方式。应采用多种影像学检查联合定位甲状旁腺并行详细术前评估；术后应严密监测血液学指标，及时处理并发症。
Abstract
Objective
2
To summarize the clinical features and the outcome of surgical treatment of refractory secondary hyperparathyroidism (SHPT) after dialysis in patients with chronic kidney disease (CKD).
Methods
2
A study was conducted on 102 CKD patients with refractory SHPT after dialysis who received surgical treatment in our hospital from January 2018 to December 2019. The clinical characteristics including hematological indicators were analyzed. The treatment outcome and postoperative complications were summarized.
Results
2
The decrement of parathyroid hormone (PTH) level on postoperative day 1 was higher than 80% of preoperative PTH level. On postoperative day 1 and day 7 and month 3
the serum levels of calcium
phosphorus and PTH were significantly decreased when compared with the preoperative values. There were 4 cases having thyroidectomy
20 cases experincing central lymph node dissection
and 10 cases undergoing thymus resection. During the perioperative period
15 patients had numbness on hands
feet and perioral area
and 2 of them had distal upper extremity convulsion. The systemic symptoms were greatly relieved in 99 patients within 1 week after surgery. There were 5 cases of permanent hypoparathyroidism and 2 cases of recurrent SHPT after operation.
Conclusion
2
Surgery is the most effective treatment for refractory SHPT. Multiple imaging examinations should be used to locate parathyroid gland
and detailed evaluation should be conducted preoperatively. During postoperative period
hematological indicators should be closely monitored and timely treatment of complications is necessary.
关键词
Keywords
references
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