發(fā)布時(shí)間：2019-04-22 17:51

【摘要】：目的回顧性分析浙江大學(xué)附屬第一醫(yī)院腎臟病中心2009年7月至2016年2月期間290例行甲狀旁腺切除術(shù)的慢性腎臟病患者的臨床資料,分析及評估手術(shù)的療效、術(shù)后的鈣磷代謝、手術(shù)的安全性等。方法收集我中心行甲狀旁腺切除術(shù)治療患者的一般情況(包括姓名,性別,接受手術(shù)時(shí)的年齡,有無進(jìn)行腎替代治療及其方式和時(shí)間,腎臟原發(fā)病),術(shù)前的臨床癥狀體征,鈣、磷、PTH及血管骨組織軟組織情況評估等。統(tǒng)計(jì)手術(shù)的方法,切除甲狀旁腺的顆數(shù),患者術(shù)后的癥狀改善情況,術(shù)后的鈣、磷、PTH指標(biāo)變化,統(tǒng)計(jì)患者的手術(shù)成功率、低鈣血癥發(fā)生率、甲狀旁腺功能低下率、持續(xù)性甲狀旁腺功能亢進(jìn)率、復(fù)發(fā)率等。結(jié)果本中心共有290例繼發(fā)性甲狀旁腺功能亢進(jìn)患者納入研究,其中男性155(53.45%)例,女性135(46.55%)例。平均年齡為46.89±11.31歲(15～77)280例行全切+前臂種植術(shù),10例行次全切手術(shù)。74例患者因合并甲狀腺腫瘤或者甲狀腺結(jié)節(jié)行甲狀腺切除術(shù)。284例患者術(shù)后1周的血甲狀旁腺激素明顯下降(下降幅度術(shù)前血甲狀旁腺激素的50%),即手術(shù)成功率為97.93%。術(shù)后250(86.21%)例患者的骨痛、瘙癢癥狀較術(shù)前明顯改善。術(shù)前的血鈣、磷、甲狀旁腺激素與術(shù)后1周相比均有顯著差異(p0.001),但術(shù)前的堿性磷酸酶與術(shù)后1周無明顯差異(p=0.128)。271(93.45%)例患者術(shù)后有低鈣血癥,14(4.18%)例患者術(shù)后有明顯麻木／抽搐,2(0.69%)例患者因低鈣血癥再次住院。34(11.50%)例患者有明顯聲音嘶�。瘑芸�,4(1.38%)例患者因手術(shù)區(qū)出血再次行清創(chuàng)止血術(shù)。1(0.34%)例患者因甲狀腺功能低下再次住院。無圍手術(shù)期死亡病例。5例為腎移植狀態(tài)患者,另3例為未行透析治療的患者。8例患者術(shù)前術(shù)后的血肌酐值并無顯著差異(P0.05)。次全切組8例有隨訪數(shù)據(jù),全切組224例有隨訪數(shù)據(jù)。次全切組與全切±種植組,兩組的術(shù)后低鈣血癥發(fā)生率有顯著差異(p0.0001)。次全切組有4(50.00%)例為持續(xù)性甲狀旁腺功能亢進(jìn),3(37.50%)例復(fù)發(fā)；全切+種植組有36(16.07%)例為持續(xù)性甲狀旁腺功能亢進(jìn),51(22.77%)例復(fù)發(fā)。術(shù)后總的持續(xù)性甲旁亢率為17.24%,總的復(fù)發(fā)率為23.28%。兩組間的持續(xù)性甲旁亢發(fā)生率有明顯差異(P=0.032)；兩組間的復(fù)發(fā)率無明顯差異(P=0.393)。結(jié)論甲狀旁腺切除術(shù)能有效治療終末期腎病患者的繼發(fā)性甲旁亢,改善鈣磷代謝紊亂。手術(shù)成功率較高,術(shù)后有一定持續(xù)性甲旁亢發(fā)生率和復(fù)發(fā)率,持續(xù)性甲狀旁腺功能低下發(fā)生率較低。術(shù)后最常見的并發(fā)癥為低鈣血癥,需術(shù)后密切監(jiān)測和加強(qiáng)隨訪。對腎移植后患者和未進(jìn)行替代治療的CKD患者,甲狀旁腺切除術(shù)對腎功能影響較小。
[Abstract]:Objective to analyze retrospectively the clinical data of 290 patients with chronic renal disease who underwent parathyroid resection from July 2009 to February 2016 in the Center of Nephropathy of the first affiliated Hospital of Zhejiang University, and to analyze and evaluate the curative effect of the operation and the metabolism of calcium and phosphorus after operation. The safety of surgery, etc. Methods the general situation (including name, sex, age at the time of operation, renal replacement therapy and its mode and time, primary disease of kidney), clinical symptoms and signs before operation were collected in our center. Evaluation of calcium, phosphorus, PTH, vascular bone tissue and soft tissue. The methods of operation, the number of parathyroid glands removed, the improvement of symptoms after operation, the changes of calcium, phosphorus and PTH after operation, the successful rate of operation, the incidence of hypocalcemia and the rate of hypoparathyroidism were counted. Persistent hyperparathyroidism rate, recurrence rate, etc. Results 290 patients with secondary hyperparathyroidism were included in the study, including 155 males (53.45%) and 135 females (46.55%). The average age was 46.89 鹵11.31 years (15 / 77). Ten patients underwent subtotal thyroidectomy. 74 patients underwent thyroidectomy due to thyroid tumors or thyroid nodules. Serum parathyroid hormone decreased significantly in 284 patients 1 week after operation (50% of pre-operative serum parathyroid hormone). The success rate of the operation was 97.93%. Bone pain and pruritus were improved in 250 (86.21%) patients after operation. There were significant differences in serum calcium, phosphorus and parathyroid hormones before operation compared with one week after operation (p0.001), but there was no significant difference in alkaline phosphatase before operation and one week after operation (p = 0.128). 271 (93.45%) patients had hypocalcemia after operation, and there was no significant difference in serum calcium, phosphorus and parathyroid hormones at one week after operation (p0.001). 14 (4.18%) patients had obvious numbness / convulsions, 2 (0.69%) patients were re-hospitalized because of hypocalcemia, 34 (11.50%) patients had obvious hoarseness / choking cough. 4 (1.38%) patients were re-treated with debridement and hemostasis because of bleeding in the operation area, and 1 (0.34%) patients were re-hospitalized because of hypothyroidism. There were no perioperative death cases. 5 cases were renal transplantation patients and 3 cases were not dialyzed. There was no significant difference in blood creatinine levels between pre-and post-operation in 8 cases (P0.05). Follow-up data were found in 8 cases of subtotal resection group and 224 cases of total resection group. There was a significant difference in the incidence of hypocalcemia between the subtotal resection group and the total cut 鹵implant group (p0.0001). There were 4 (50.00%) cases of persistent hyperparathyroidism and 3 (37.50%) cases of recurrence in subtotal resection group and 36 (16.07%) cases of persistent hyperparathyroidism and 51 (22.77%) cases of persistent hyperparathyroidism in total resection group. The total persistent hyperparathyroidism rate and recurrence rate were 17.24% and 23.28% respectively. There was a significant difference in the incidence of persistent hyperparathyroidism between the two groups (P = 0.032), while there was no significant difference in recurrence rate between the two groups (P = 0.393). Conclusion Parathyroidectomy can effectively treat secondary hyperparathyroidism and improve calcium and phosphorus metabolism disorder in patients with end-stage renal disease. The rate of postoperative persistent hyperparathyroidism was higher and the incidence of persistent hypoparathyroidism was lower. Hypocalcemia is the most common complication after operation and should be closely monitored and followed up. Parathyroid resection had little effect on renal function in patients with renal transplantation and in patients with CKD without replacement therapy.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R653

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 郝國強(qiáng);邢壯杰;鄧芝徽;李潤生;趙暉;鄭新;;甲狀旁腺切除術(shù)治療繼發(fā)性甲狀旁腺功能亢進(jìn)的療效觀察與分析[J];安徽醫(yī)藥;2013年11期

2 徐少明;內(nèi)鏡下微創(chuàng)甲狀旁腺切除術(shù)[J];中國實(shí)用外科雜志;2002年10期

3 孫誠誼;甲狀旁腺切除術(shù)用于伴原發(fā)性甲狀旁腺機(jī)能亢進(jìn)癥臨床特征的家族性高鈣血癥以及家族性低尿鈣性高鈣血癥[J];國外醫(yī)學(xué).外科學(xué)分冊;2002年05期

4 張凌,劉亞綿,卞維靜,李程,趙麗,杜學(xué)海;化學(xué)性甲狀旁腺切除術(shù)治療慢性透析患者繼發(fā)甲狀旁腺功能亢進(jìn)[J];中國血液凈化;2002年02期

5 陳曦,何永剛,楊衛(wèi)平,李宏為,Yves Chapuis,Philippe Bonnichon;局麻下小切口甲狀旁腺切除術(shù):甲狀旁腺手術(shù)的另一個(gè)選擇[J];外科理論與實(shí)踐;2003年04期

6 顧斐;甲狀旁腺切除術(shù)前后的區(qū)域腦血流[J];國外醫(yī)學(xué).外科學(xué)分冊;2004年01期

7 劉鳳軍,胡三元,薛瑞華,軒詩進(jìn),朱民;腹腔鏡甲狀旁腺切除術(shù)[J];中華普通外科雜志;2005年06期

8 劉君,王家東;甲狀旁腺切除術(shù)治療繼發(fā)性甲狀旁腺功能亢進(jìn)[J];中國耳鼻咽喉頭頸外科;2005年07期

9 姚力;張凌;劉鵬;卞維靜;花瞻;張建榮;李文歌;諶貽璞;;甲狀旁腺切除術(shù)治療難治性甲狀旁腺功能亢進(jìn)癥89例療效評價(jià)[J];中國血液凈化;2009年08期

10 張凌;王文博;;繼發(fā)性甲狀旁腺功能亢進(jìn)癥的不同甲狀旁腺切除術(shù)式治療[J];中國血液凈化;2011年05期

相關(guān)會(huì)議論文 前3條

1 張凌;卞維靜;劉亞綿;李程;;化學(xué)性甲狀旁腺切除術(shù)治療慢性透析患者繼發(fā)甲狀旁腺功能亢進(jìn)[A];第八屆全國骨質(zhì)疏松年會(huì)暨第五屆全國鈣劑年會(huì)會(huì)議文集[C];2002年

2 鄭塵非;劉毅;徐玉蘭;;甲狀旁腺切除術(shù)治療體會(huì)[A];“中華醫(yī)學(xué)會(huì)腎臟病學(xué)分會(huì)2004年年會(huì)”暨“第二屆全國中青年腎臟病學(xué)術(shù)會(huì)議”論文匯編[C];2004年

3 林小敏;梅曉蓉;王環(huán);葉一蓓;;尿毒癥患者施行不同方式甲狀旁腺切除術(shù)的臨床觀察及護(hù)理[A];2008年浙江省腎臟病學(xué)術(shù)年會(huì)論文匯編[C];2008年

相關(guān)重要報(bào)紙文章 前1條

1 董智永;國內(nèi)首例腔鏡下甲狀旁腺切除術(shù)完成[N];保健時(shí)報(bào);2003年

相關(guān)博士學(xué)位論文 前2條

1 賈曉妍;不同手術(shù)方式治療慢性腎臟病甲狀旁腺功能亢進(jìn)長期預(yù)后的系統(tǒng)評價(jià)[D];山東大學(xué);2015年

2 董建宇;455例甲狀旁腺功能亢進(jìn)患者病歷回顧性分析[D];北京協(xié)和醫(yī)學(xué)院;2009年

相關(guān)碩士學(xué)位論文 前4條

1 任捷藝;甲狀旁腺切除術(shù)治療慢性腎臟病繼發(fā)性甲狀旁腺功能亢進(jìn)的療效[D];蘇州大學(xué);2015年

2 夏巧靜;手術(shù)治療繼發(fā)性甲狀旁腺功能亢進(jìn)癥的臨床療效分析[D];浙江大學(xué);2016年

3 張晶晶;甲狀旁腺切除術(shù)對慢性腎衰竭患者血清瘦素水平的影響及治療尿毒癥獅面臉的病例報(bào)告[D];南京醫(yī)科大學(xué);2014年

4 陳辰;甲狀旁腺切除術(shù)對伴難治性繼發(fā)性甲狀旁腺功能亢進(jìn)維持性透析患者腎性貧血及營養(yǎng)狀況的影響[D];遵義醫(yī)學(xué)院;2014年

，

本文編號(hào)：2463057