發(fā)布時間：2018-06-11 17:17

  本文選題：繼發(fā)性甲狀旁腺功能亢進 + 甲狀旁腺全切除術��； 參考：《新疆醫(yī)科大學》2017年碩士論文

【摘要】：目的:1.了解單純骨化三醇沖擊治療難治性繼發(fā)性甲狀旁腺功能亢進(Secondary hyperparathyroidism SHPT)患者6個月的鈣、磷、全段甲狀旁腺激素(intact parathyroid hormone iPTH)、鈣磷乘積、治療后癥狀的改善,并發(fā)癥的狀況。2.了解甲狀旁腺全切術(total parathyroidectomy t-PTX)治療難治性SHPT患者6個月的鈣、磷、iPTH、鈣磷乘積、術后癥狀的改善,并發(fā)癥及復發(fā)率的狀況。3.了解口服擬鈣劑治療難治性SHPT患者6個月的鈣、磷、iPTH、鈣磷乘積、治療后癥狀的改善,并發(fā)癥的狀況。4.對比t-PTX、口服擬鈣劑與單純骨化三醇沖擊治療難治性SHPT患者6個月的鈣、磷、iPTH、鈣磷乘積、術后癥狀的改善,并發(fā)癥及復發(fā)率的狀況。評估三組的短期療效。5.通過療效對比,來指導難治性SHPT的治療。方法:對2012年1月至2015年9月我院收治的118例難治性SHPT患者,118例難治性SHPT患者均進行常規(guī)內科治療,包括低磷飲食、充分的血液透析或腹膜透析、規(guī)律注射促紅素和降壓等對癥支持治療。其中62例難治性SHPT患者在常規(guī)內科治療的基礎上行單純骨化三醇沖擊治療為A組;26例難治性SHPT患者在常規(guī)內科治療的基礎上行t-PTX治療為B組;30例難治性SHPT患者在常規(guī)內科治療的基礎上口服擬鈣劑治療為C組。對以上患者臨床資料進行回顧性分析。三組患者均完成治療前、第1天、第1月、第3月、第6月的鈣、磷、鈣磷乘積、iPTH、術后癥狀的改善、并發(fā)癥及術后復發(fā)率的隨訪。結果:1.62例難治性SHPT患者行單純骨化三醇沖擊治療第1天、第1月、第3月、第6月的鈣、磷、全段甲狀旁腺激素、鈣磷乘積與治療前五統(tǒng)計學差異。治療后1月內癥狀改善率為25.80%,1月內癥狀改善率為24.19%,3月內癥狀改善率為12.90%,6月內癥狀改善率為3.22%。6月內發(fā)生2例自發(fā)性骨折和1例泌尿系結石病人。2.26例難治性SHPT患者在常規(guī)內科治療的基礎上行t-PTX治療第1天、第1月、第3月、第6月的磷、全段甲狀旁腺激素、鈣磷乘積與術前有統(tǒng)計學差異;治療后第1月、第3月、第6月的鈣與術前有統(tǒng)計學差異;治療后第1天的鈣與術前無統(tǒng)計學差異。治療后1月內癥狀改善率為96.15%,1月內癥狀改善率為96.15%,3月內癥狀改善率為92.30%,6月內癥狀改善率為92.30%。術后1月內有2例患者出現(xiàn)明顯的手足麻木癥狀,無其他并發(fā)癥。6月內有1例復發(fā),復發(fā)率為3.84%。3.30例難治性SHPT患者在常規(guī)內科治療的基礎上口服擬鈣劑治療第1天、第1月、第3月、第6月的鈣、磷、全段甲狀旁腺激素、鈣磷乘積與術前有統(tǒng)計學差異。治療后1月內癥狀改善率為86.67%,1月內癥狀改善率為83.33%,3月內癥狀改善率為66.67%,6月內癥狀改善率為60.00%。術后6月內有2例患者出現(xiàn)明顯的手足麻木癥狀,無其他并發(fā)癥。4.B組和C組較A組鈣磷乘積點磷、鈣磷乘積、血清全段甲狀旁腺激素(intact parathyroid hormone iPTH)均顯著降低(P0.05)。C組與A組治療后各時點鈣比較無統(tǒng)計學意義(P0.05)。B組與A組治療后各時點鈣比較均顯著降低,有統(tǒng)計學意義(P.05)。B組與C組治療后各時點鈣、磷、鈣磷乘積、iPTH均顯著降低,有統(tǒng)計學意義(P0.05)。結論:單純骨化三醇沖擊治療難治性SHPT患者無明顯優(yōu)勢。1行t-PTX時治療難治性SHPT患者的首選、有效方式。2.口服擬鈣劑治療為難治性SHPT患者提供了非手術治療的可能。3.仍需長期隨訪,觀察長期療效。
[Abstract]:Objective: 1. to understand the 6 months of calcium, phosphorus, total parathyroid hormone (intact parathyroid hormone iPTH), calcium and phosphorus product (intact parathyroid hormone iPTH), the improvement of the symptoms after treatment, and the status of the complications (total P) (total P) for patients with refractory secondary hyperparathyroidism (Secondary hyperparathyroidism SHPT). Arathyroidectomy t-PTX) treatment of refractory SHPT patients for 6 months of calcium, phosphorus, iPTH, calcium and phosphorus products, improvement of postoperative symptoms, complications and recurrence rates,.3. to understand the calcium, phosphorus, iPTH, calcium and phosphorus products of refractory SHPT patients for 6 months in treatment of refractory SHPT patients, improvement of postoperative symptoms, complications of.4. contrast t-PTX, oral calcium agent and oral administration of calcium Simple ossification three alcohol shock treatment for refractory SHPT patients 6 months of calcium, phosphorus, iPTH, calcium and phosphorus product, postoperative symptoms improvement, complications and recurrence rates. Evaluate the short-term efficacy of three groups.5. through the curative effect comparison, to guide the treatment of refractory SHPT. Methods: 118 cases of refractory SHPT patients admitted to our hospital from January 2012 to September 2015, 118 Cases of refractory SHPT patients were treated with routine medical treatment, including low phosphorus diet, adequate hemodialysis or peritoneal dialysis, regular injection of erythropoietin and antihypertensive therapy. 62 patients with refractory SHPT were treated with simple ossification and three alcohol shock therapy on the basis of routine internal medicine treatment, and 26 cases of refractory SHPT patients were in the routine. 30 patients with refractory SHPT were treated as group B, and 30 patients with refractory SHPT were treated in group C on the basis of routine medical treatment. The clinical data of the patients were analyzed retrospectively. The three groups were completed before treatment, first days, first months, third months, sixth months of calcium, phosphorus, calcium and phosphorus products, iPTH, postoperative symptoms improved, complicated, Results: 1.62 cases of refractory SHPT patients were treated with simple ossification of three alcohol shock for first days, first months, third months, sixth months of calcium, phosphorus, total parathyroid hormone, calcium and phosphorus product and five before treatment. The improvement rate of symptoms in January was 25.80%, the symptom improvement rate was 24.19% in January, and the symptoms were improved in March. The rate of improvement was 12.90% in June. In June, the improvement rate was 2 cases of spontaneous fracture in 3.22%.6 months and 1 cases of urinary calculi in.2.26 patients. T-PTX treatment was performed on the basis of routine internal medicine treatment. First months, third months, sixth months of phosphorus, total parathyroid hormone, calcium and phosphorus product were statistically different from preoperative, and first months after treatment, Third months, sixth months of calcium and preoperative statistically significant difference, first days after the treatment of calcium and no statistical difference before the treatment. After the treatment in January, the symptom improvement rate was 96.15%, the symptom improvement rate in January was 96.15%, the symptom improvement rate was 92.30% in March, and in June, the symptom improvement rate was 92.30%. in January, there were 2 patients with obvious numbness of hand and foot. The recurrence rate was 1 cases in.6 months, and the recurrence rate was 3.84%.3.30 cases of refractory SHPT patients on the basis of routine medical treatment for first days, first months, third months, sixth months of calcium, phosphorus, total parathyroid hormone, calcium and phosphorus product and preoperative statistical difference. After treatment, the improvement rate of symptoms in January was 86.67%, and the symptoms changed in January. The good rate was 83.33%, the symptom improvement rate in March was 66.67%. In June, the symptom improvement rate was 2 cases in June. There were 2 patients with obvious sign of hand and foot numbness, no other complications in group.4.B and C group were compared with A group calcium phosphorus product point phosphorus, calcium phosphorus product, and serum total parathyroid hormone (intact parathyroid hormone iPTH) significantly decreased (P0.05).C. The calcium comparison of group.B and group A was not statistically significant (P0.05) in group.B and group A after treatment, the calcium comparison of each time point was significantly decreased. There was statistical significance (P.05) in group.B and group C after treatment, calcium, phosphorus, calcium and phosphorus products, iPTH were significantly reduced, and statistically significant (P0.05). Conclusion: simple ossification of three alcohol shock treatment of refractory SHPT patients The first choice for the treatment of refractory SHPT patients when the obvious advantage of.1 t-PTX is to treat patients with refractory SHPT. The effective way of.2. oral calcium preparation is to provide non operative treatment for refractory SHPT patients. The long-term follow-up is still needed and the long-term effect is observed.
【學位授予單位】：新疆醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R692.5;R653

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