| 摘要: |
| ［摘要］ 目的 分析慢性肾脏病继发性甲状旁腺功能亢进(SHPT)患者术后持续/复发再手术治疗对策和临床效果。方法 回顾性分析2013年1月至2021年11月广西中医药大学第一附属医院收治的20例SHPT术后持续/复发患者的临床资料，总结SHPT持续/复发再手术指征、术前甲状旁腺影像学定位检查方法、手术方式，以及术中全段甲状旁腺素(iPTH)测定、甲状旁腺探查切除策略。观察再手术患者术后症状、iPTH、血钙、血磷等指标变化情况。结果 该组20例患者共切除32枚病变甲状旁腺，术前经多学科医师协作共同阅片分析，联合彩色多普勒超声、CT扫描，甲状旁腺定位准确率达93.55%（29/31）。患者术后骨痛及皮肤瘙痒症状消失，术后血iPTH、血钙、血磷水平与术前比较均显著降低(P<0.05)。20例患者术后均未发生严重低钙血症及其他严重并发症，随访期间无SHPT持续/复发发生。结论 联合多种影像学检查及多学科医师协作共同阅片，可提高再手术前甲状旁腺定位准确率，采用甲状旁腺全切治疗SHPT持续/复发的临床效果良好。 |
| 关键词: 继发性甲状旁腺功能亢进症 持续性 复发 甲状旁腺切除术 再手术 |
| DOI：10.3969/j.issn.1674-3806.2023.07.17 |
| 分类号:R 605 |
| 基金项目:广西科学研究与技术开发计划项目（编号：桂科攻1598012-15） |
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| Strategies and clinical effect analysis of postoperative continuous/recurrent reoperation in patients with chronic renal disease secondary hyperparathyroidism |
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LIAO Dan, LIU De-guo, LI Qi-shang
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Department of Thyroid and Breast Surgery, the First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning 530023, China
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| Abstract: |
| ［Abstract］ Objective To analyze the strategies and clinical effects of postoperative continuous/recurrent reoperation in patients with chronic renal disease secondary hyperparathyroidism(SHPT). Methods The clinical data of 20 patients with continuous /recurrent SHPT after surgery who were admitted to the First Affiliated Hospital of Guangxi University of Chinese Medicine from January 2013 to November 2021 were retrospectively analyzed. The indications of reoperation of continuous/recurrent SHPT, methods of preoperative imaging localization of parathyroid glands, operative methods, intraoperative determination of intact parathyroid hormone(iPTH) and strategies for exploration and resection of parathyroid glands were summarized. The changes of the indicators including postoperative symptoms, iPTH, blood calcium and blood phosphorus were observed in patients undergoing reoperation. Results In this study, a total of 32 diseased parathyroid glands were resected in the 20 patients, and the accuracy rate of parathyroid localization reached 93.55%(29/31) through the preoperative radiograph reading analysis with the cooperation of multidisciplinary physicians, and combining with color Doppler ultrasound and computed tomography(CT) scanning. The symptoms of bone pain and skin pruritus disappeared after surgery. The levels of blood iPTH, calcium and phosphorus after operation were significantly decreased compared with those before operation(P<0.05). None of the 20 patients suffered from severe hypocalcemia or other serious complications after surgery, and no continuous/recurrent SHPT occurred during the follow-up. Conclusion Combining with multiple imaging examinations and joint X-ray film reading through multidisciplinary physicians can improve the accuracy rate of parathyroid location before surgery, and the clinical effects of total parathyroid resection are good in the treatment of continuous/recurrent SHPT. |
| Key words: Secondary hyperparathyroidism(SHPT) Continuity Recurrence Parathyroidectomy Reoperation |
