«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

29卷

期数:

2023年04期

页码:

436-440

栏目:

临床医学

出版日期:

2023-07-10

文章信息/Info

Title:

Comparison of therapeutic effect of total parathyroidectomy plus autologous transplantation and paricalcitol in the treatment of secondary hyperparathyroidism

文章编号:

1006-8147（2023）04-0436-04

作者:

刘鹏

天津市职业病防治院普外科，天津 300011

Author(s):

LIU Peng

Department of General Surgery，Tianjin Occupational Disease Prevention and Control Hospital，Tianjin 300011，China

关键词:

继发性甲状旁腺功能亢进症; 甲状旁腺全切+自体移植术; 帕立骨化醇

Keywords:

secondary hyperparathyroidism; total parathyroidectomy+autotransplantation; paricalcitol

分类号:

R6

DOI:

-

文献标志码:

A

摘要:

目的：比较继发性甲状旁腺功能亢进症患者行甲状旁腺全切+自体移植术或行帕立骨化醇治疗的疗效。方法：选择天津市职业病防治院2015年1月—2021年12月甲状旁腺功能亢进症患者共40例，其中应用帕立骨化醇注射治疗组（注射组）与甲状旁腺全切+自体移植术治疗组（手术组）各20例，注射组每次透析结束后将帕立骨化醇10μg通过透析通路注射入体内，手术组患者接受甲状旁腺全切+前臂自体移植手术，于治疗前及治疗4周后检测患者血甲状旁腺激素（PTH）、血钙、血磷、血尿素氮（BUN）、血肌酐（Scr）。观察并记录不良反应发生情况。结果：手术组在PTH、血钙、血磷、BUN、Scr的下降程度均高于注射治疗组，差异均有统计学意义（t=1.74～3.95，均P＜0.05）。和注射组相比，手术组治疗有效率更高（χ2=26.17，P<0.05），不良反应发生率更低（χ2=15.35，P<0.05）。结论：对于长期难治性甲状旁腺功能亢进症患者，甲状旁腺全切+自体移植术疗效明显优于帕立骨化醇注射治疗。

Abstract:

Objective：To compare the efficacy of total parathyroidectomy with autologous transplantation or paricalcitol treatment in patients with secondary hyperparathyroidism. Methods：A total of 40 patients with hyperparathyroidism were selected in Tianjin Occupational Disease Prevention and Control Hospital from January 2015 to December 2021，including 20 patients in the paricalcitol injection treatment group（ injection group） and 20 patients in the treatment group（ surgical group） treated with total parathyroidectomy and autologous transplantation. After each dialysis，the injection group received 10 μg of Paroxycarbinol which was injected into the body through a dialysis pathway，and patients in the surgical group underwent total parathyroidectomy and forearm autotransplantation surgery. Before and after 4 weeks of treatment，the patients′blood PTH，blood calcium，blood phosphorus，blood urea nitrogen（ BUN），and blood creatinine（ Scr） were measured. The occurrence of adverse reactions were observed and recorded. Results：The decrease in PTH，blood calcium，blood phosphorus，BUN，and Scr in the surgical group were higher than those in the injection treatment group，and the differences were statistically significant（ t=1.74-3.95，all P<0.05）. Compared with the injection group，the surgical group had a higher treatment effectiveness rate（ χ2=26.17，P<0.05） and a lower incidence of adverse reactions（ χ2=15.35，P<0.05）. Conclusion：For patients with long-term refractory hyperparathyroidism，the efficacy of total parathyroidectomy combined with autologous transplantation is significantly better than that of paricalcitol injection therapy.

参考文献/References:

[1] HIRAMITSU T，HASEGAWA Y，FUTAMURA K，et al. Treatment for secondary hyperparathyroidism focusing on parathyroidectomy[J]. Front Endocrinol（ Lausanne），2023 14：1169793.
[2] LUI M S，SHIRALI A S，HUANG B L，et al. Advances in endocrine surgery[J]. Surg Oncol Clin N Am，2023，32（ 1）：199-220.
[3] 赵蕾. 两种术式治疗治疗继发性甲状旁腺亢进的近期随访比较[J].中华普外科手术学杂志，2021，15（ 6）：683-685.
[4] GUO X L，YIN W Y. A preoperative parathyroid scan is important for the total removal of the transplanted parathyroid tissue in recurrent secondary hyperthyroidism：a case report and literature review [J]. Medicine（ Baltimore），2022，101（ 51）：e32453.
[5] 张开绚. 帕立骨化醇对维持性血液透析患者继发性甲状旁腺功能亢进症的治疗效果观察[J]. 基层医学论坛，2021，25（ 34）：4909-4912.
[6] 薛亚东. 帕立骨化醇治疗继发性甲状旁腺功能亢进的疗效观察[J].临床医药实践，2021，30（ 12）：912-914.
[7] CHEN X，ZHAO F，PAN W J，et al. Paricalcitol in hemodialysis patients with secondary hyperparathyroidism and its potential bene－fits[J]. World J Clin Cases，2021，9（ 33）：10172-10179.
[8] 鲁华，霍鹏飞，王晶，等.不同起始剂 量 的帕立骨化醇治疗血液透析伴继发性甲状旁腺功能亢进患者的有效性[J].中国现代医生， 2021，59（ 18）：43-46.
[9] NUMANO M，TOMINAGA Y，UCHIDA K，et al. Surgical signifi－cance of supernumerary parathyroid glands in renal hyperparathy－roidism[J]. World J Surg，1998，22（ 10）：1098-1102.
[10] CHEN Y，LIANG B，DONG X，et al. Diagnostic accuracy of intra－operative intact parathyroid hormone monitoring for surgical out－comes of secondary hyperparathyroidism[J]. Med Sci Monit，2021，27：e932556.
[11] LI Y，YUAN L，XU B.Outcomes of limited parathyroidectomy in se－condary hyperparathyroidism[J]. J Coll Physicians Surg Pak，2022， 32（ 11）：1386-1391.
[12]麦峻豪. 甲状腺癌合并甲状腺功能亢进症病例的临床特征分析[J].中国当代医药，2022，29（ 36）：90-93.
[13] DIETHELM A G，ADAMS P L，MURAD T M，et al. Treatment of secondary hyperparathyroidism in patients with chronic renal failure by total parathyroidectomy and parathyroid autograft[J]. Ann Surg， 1981，193（ 6）：777-793.
[14]唐海利，杨小军，陆建国，等.甲状腺全切除术后甲状旁腺功能减退的影响因素分析[J].海南医学，2021，32（ 10）：1276-1278.
[15] NASIRI S，MESHKATI YAZD S M，KAMRAN H，et al. Autotrans－plantation of parathyroid tissue into subcutaneous subclavicular area following total parathyroidectomy in secondary hyperparathy－roidism[J]. J Endocrinol Invest，2022，45（ 12）：2291-2297.
[16] GONG X，WANG Y A，LI C，et al. Effect of total parathyroidectomy in patients with secondary hyperparathyroidism：a retrospective study[J]. Int Urol Nephrol，2023，55（ 5）：1239-1245.
[17]汪茂林，李菊兰，鲜昆仑.继发性甲旁亢甲状旁腺切除不同移植方案疗效研究[J].山东大学耳鼻喉眼学报，2020，34（3）：114-119.
[18]李梦思，张胜初.甲状腺癌根治术联合甲状旁腺自体移植的临床观察[J].中国医药科学，2022，12（ 19）：186-188.
[19]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].陆军军医大学学学报，2022， 44（ 24）：2530-2536.
[20] SCHNEIDER R，SLATER EP，KARAKAS E，et al. Initial parathy－roid surgery in 606 patients with renal hyperparathyroidism [J]. World J Surg，2012，36（ 2）：318-326.
[21] ZHAO S，GAN W，XIE W，et al. A single-center experience of parathyroidectomy in 1 500 cases for secondary hyperparathy－roidism：a retrospective study[J]. Ren Fail，2022 44（ 1）：23-29.

相似文献/References:

备注/Memo

备注/Memo:

作者简介刘鹏（1983-），男，医师，学士，研究方向：普通外科，E-mail：527931788@qq.com。

常用功能

更新日期/Last Update: 2023-07-10