甲狀旁腺全切除術治療繼發性甲狀旁腺功能亢進12例分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 王濤 ¹ , 張立洪 ¹ , 邱晶晶 ¹ , 芮坤 ¹ , 馮影 ¹ , 顧繼禮 ¹ , 李海濤 ² , 余健 ³

1. ;
2. ;
3. ;

Corresponding?author：

王濤, Email: txwangt168@sina.com

Keywords：

繼發性甲狀旁腺功能亢進; 甲狀旁腺全切除術

DOI：

10.7507/1007-9424.20150393

Video：

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目的總結應用甲狀旁腺全切除且不移植手術治療繼發性甲狀旁腺功能亢進（SHPT）在圍手術期的處理經驗。方法對我院2012年12月至2015年1月期間12例SHPT患者行甲狀旁腺全切除且不移植手術的療效進行回顧性分析，比較術前、術后血甲狀旁腺激素（PTH）、血鈣、血磷、血清堿性磷酸酶（AKP）值及臨床癥狀改善情況。結果 12例患者術后骨痛、皮膚瘙癢癥狀明顯緩解，血PTH值術后迅速下降，6個月后恢復至正常范圍，血鈣均迅速下降并低于正常，AKP指標下降緩慢，血磷指標恢復正常。隨訪1～2年未出現復發。1例患者于術后4個月死于腦血管意外。結論甲狀旁腺全切除且不移植治療SHPT安全、有效，低鈣血癥是術后防治重點，多學科協作治療有利于患者平穩渡過圍手術期。

Citation： 王濤, 張立洪, 邱晶晶, 芮坤, 馮影, 顧繼禮, 李海濤, 余健. 甲狀旁腺全切除術治療繼發性甲狀旁腺功能亢進12例分析. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(12): 1513-1514. doi: 10.7507/1007-9424.20150393 Copy

1.	張凌, 閆彩蕓, 姚力.難治性繼發性甲狀旁腺功能亢進癥的外科治療.中國血液凈化, 2012, 11(7): 349-351.
2.	馬麗潔, 趙素梅, 劉婧, 等.甲狀旁腺切除術對血液透析患者合并繼發性甲狀旁腺功能亢進骨代謝及骨密度的影響.中華腎臟病雜志, 2015, 31(1): 13-18.
3.	張海東, 龔單春, 劉亞群, 等.甲狀腺全切手術中甲狀旁腺的保護.中華耳鼻咽喉頭頸外科雜志, 2014, 49(11): 889-892.
4.	邵選, 潘永海, 吳成亮, 等.精細被膜解剖法原位保留甲狀旁腺的臨床應用.實用醫學雜志, 2009, 25(13): 2110-2111.
5.	王松, 代文杰.困難甲狀旁腺手術的技術要點.中國普外基礎與臨床雜志, 2013, 20(1): 92-94.
6.	陳雋, 王家東.應用99mTc-MIBI術中定位的甲狀旁腺切除術治療繼發性甲狀旁腺功能亢進的研究.中華內分泌外科雜志, 2012, 6(1): 39-41, 45.
7.	Sakman G, Parsak CK, Balal M, et al. Outcomes of total parathyroi-dectomy with autotransplantation versus subtotal parathyroidec-tomy with routine addition of thymectomy to both groups: single center experience of secondary hyperparathyroidism. Balkan Med J, 2014, 31(1): 77-82.
8.	Jia X, Wang R, Zhang C, et al. Long-term outcomes of total parath-yroidectomy with or without autoimplantation for hyperparathyroi-dism in chronic kidney disease: a meta-analysis. Ther Apher Dial, 2015 May 6. [Epub ahead of print].
9.	Conzo G, Perna A, Candela G, et al. Long-term outcomes following "presumed" total parathyroidectomy for secondary hyperparathyroi-dism of chronic kidney disease. G Chir, 2012, 33(11/12): 379-382.
10.	Pattou FN, Pellissier LC, No?l C, et al. Supernumerary parathyroid glands: frequency and surgical significance in treatment of renal hyperparathyroidism. World J Surg, 2000, 24(11): 1330-1334.
11.	Iwamoto N, Sato N, Nishida M, et al. Total parathyroidectomy improves survival of hemodialysis patients with secondary hyper-parathyroidism. J Nephrol, 2012, 25(5): 755-763.
12.	Oltmann SC, Madkhali TM, Sippel RS, et al. Kidney disease impro-ving global outcomes guidelines and parathyroidectomy for renal hyperparathyroidism. J Surg Res, 2015 Apr 18. [Epub ahead of print].
13.	Coulston JE, Egan R, Willis E, et al. Total parathyroidectomy without autotransplantation for renal hyperparathyroidism. Br J Surg, 2010, 97(11): 1674-1679.
14.	Abboud B, Sleilaty G, Ayoub S, et al. Intrathyroid parathyroid adenoma in primary hyperparathyroidism: can it be predicted preoperatively? World J Surg, 2007, 31(4): 817-823.
15.	Kuo LE, Wachtel H, Karakousis G, et al. Parathyroidectomy in dialysis patients. J Surg Res, 2014, 190(2): 554-558.

1. 張凌, 閆彩蕓, 姚力.難治性繼發性甲狀旁腺功能亢進癥的外科治療.中國血液凈化, 2012, 11(7): 349-351.
2. 馬麗潔, 趙素梅, 劉婧, 等.甲狀旁腺切除術對血液透析患者合并繼發性甲狀旁腺功能亢進骨代謝及骨密度的影響.中華腎臟病雜志, 2015, 31(1): 13-18.
3. 張海東, 龔單春, 劉亞群, 等.甲狀腺全切手術中甲狀旁腺的保護.中華耳鼻咽喉頭頸外科雜志, 2014, 49(11): 889-892.
4. 邵選, 潘永海, 吳成亮, 等.精細被膜解剖法原位保留甲狀旁腺的臨床應用.實用醫學雜志, 2009, 25(13): 2110-2111.
5. 王松, 代文杰.困難甲狀旁腺手術的技術要點.中國普外基礎與臨床雜志, 2013, 20(1): 92-94.
6. 陳雋, 王家東.應用99mTc-MIBI術中定位的甲狀旁腺切除術治療繼發性甲狀旁腺功能亢進的研究.中華內分泌外科雜志, 2012, 6(1): 39-41, 45.
7. Sakman G, Parsak CK, Balal M, et al. Outcomes of total parathyroi-dectomy with autotransplantation versus subtotal parathyroidec-tomy with routine addition of thymectomy to both groups: single center experience of secondary hyperparathyroidism. Balkan Med J, 2014, 31(1): 77-82.
8. Jia X, Wang R, Zhang C, et al. Long-term outcomes of total parath-yroidectomy with or without autoimplantation for hyperparathyroi-dism in chronic kidney disease: a meta-analysis. Ther Apher Dial, 2015 May 6. [Epub ahead of print].
9. Conzo G, Perna A, Candela G, et al. Long-term outcomes following "presumed" total parathyroidectomy for secondary hyperparathyroi-dism of chronic kidney disease. G Chir, 2012, 33(11/12): 379-382.
10. Pattou FN, Pellissier LC, No?l C, et al. Supernumerary parathyroid glands: frequency and surgical significance in treatment of renal hyperparathyroidism. World J Surg, 2000, 24(11): 1330-1334.
11. Iwamoto N, Sato N, Nishida M, et al. Total parathyroidectomy improves survival of hemodialysis patients with secondary hyper-parathyroidism. J Nephrol, 2012, 25(5): 755-763.
12. Oltmann SC, Madkhali TM, Sippel RS, et al. Kidney disease impro-ving global outcomes guidelines and parathyroidectomy for renal hyperparathyroidism. J Surg Res, 2015 Apr 18. [Epub ahead of print].
13. Coulston JE, Egan R, Willis E, et al. Total parathyroidectomy without autotransplantation for renal hyperparathyroidism. Br J Surg, 2010, 97(11): 1674-1679.
14. Abboud B, Sleilaty G, Ayoub S, et al. Intrathyroid parathyroid adenoma in primary hyperparathyroidism: can it be predicted preoperatively? World J Surg, 2007, 31(4): 817-823.
15. Kuo LE, Wachtel H, Karakousis G, et al. Parathyroidectomy in dialysis patients. J Surg Res, 2014, 190(2): 554-558.

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甲狀旁腺全切除術治療繼發性甲狀旁腺功能亢進12例分析

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