本文選題：繼發(fā)性甲狀旁腺功能亢進(jìn) + 99mTc—MIBI引導(dǎo)下的甲狀旁腺切除術(shù)�。� 參考：《上海交通大學(xué)》2015年碩士論文

【摘要】：目的:分析三種外科手術(shù)方式治療繼發(fā)性甲狀旁腺功能亢進(jìn)的短期及長期療效。方法:回顧性分析自2004年10月至2014年10月于上海交通大學(xué)醫(yī)學(xué)院附屬仁濟(jì)醫(yī)院因繼發(fā)性甲狀旁腺功能亢進(jìn)行甲狀旁腺切除術(shù)的病例共88例。病例分為3組,組I行甲狀旁腺次全切除術(shù),組II行甲狀旁腺全切+前臂移植術(shù),組III行99m Tc—MIBI引導(dǎo)下的甲狀旁腺全切+前臂移植術(shù)。收集3組病例術(shù)前、術(shù)后短期(≤6月)及術(shù)后長期(6月)的血鈣、血磷、血PTH的結(jié)果及臨床癥狀改善程度和術(shù)后復(fù)發(fā)率及并發(fā)癥等資料。結(jié)果:三組術(shù)后臨床癥狀均較術(shù)前有明顯改善。組I和組II術(shù)后短期內(nèi)血鈣、血PTH及術(shù)后短期復(fù)發(fā)率均無統(tǒng)計(jì)學(xué)差異。組III術(shù)后短期內(nèi)血鈣、血PTH及術(shù)后短期復(fù)發(fā)率均低于組I及組II,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。三組術(shù)后血磷值無統(tǒng)計(jì)學(xué)差異。組III手術(shù)時(shí)間明顯短組II手術(shù)時(shí)間,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。組III切除的甲狀旁腺陽性率高于組II,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。經(jīng)過長期隨訪,組I與組II的術(shù)后血鈣、血磷、血PTH及術(shù)后復(fù)發(fā)率均無統(tǒng)計(jì)學(xué)差異。組III的術(shù)后復(fù)發(fā)率均低于組I及組II的術(shù)后復(fù)發(fā)率,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:治療繼發(fā)性甲狀旁腺功能亢進(jìn),甲狀旁腺全切+前臂移植有著較好的療效,而99m Tc—MIBI引導(dǎo)下的甲狀旁腺全切+前臂移植術(shù)則可更好的發(fā)現(xiàn)異位及額外的甲狀旁腺,提高手術(shù)成功率,同時(shí)術(shù)中可無需等待冰凍病理,縮短手術(shù)時(shí)間。在術(shù)后隨訪中,復(fù)發(fā)率也較低,是一種安全及有效的治療方式。
[Abstract]:Objective: to analyze the short-term and long-term efficacy of three surgical methods in the treatment of secondary hyperparathyroidism. Methods: 88 cases of secondary hyperparathyroidism in Renji Hospital affiliated to Shanghai Jiaotong University Medical College from October 2004 to October 2014 were retrospectively analyzed. The patients were divided into 3 groups: group I underwent subtotal parathyroidectomy, group II underwent total parathyroidectomy forearm transplantation, group III underwent total parathyroid gland resection under 99m Tc-MIBI guidance. The data of serum calcium, phosphorus, PTH, clinical symptom improvement, recurrence rate and complications were collected in three groups of patients before operation, short period after operation (鈮，

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