超声引导下经皮穿刺射频消融术治疗尿毒症难治性继发性甲状旁腺功能亢进的临床疗效分析

The Clinical Efficacy Analysis of Ultrasound Guided Percutaneous Radiofrequency Ablation in the Treatment of Uremic Refractory Secondary Hyperparathyroidism

摘要: 目的：探讨超声引导下经皮穿刺射频消融术治疗尿毒症难治性继发性甲状旁腺功能亢进的临床疗效。方法：选取30例尿毒症继发甲状旁腺功能亢进患者，于高频超声引导下行经皮穿刺射频消融治疗，观察患者治疗前后血清甲状旁腺激素、血清钙及血清磷等指标变化，评价临床疗效及术后不良反应。结果：共消融增生甲状旁腺118枚。与治疗前比较，治疗后1 d、3 d、1 w、1 m、3 m、6 m及10 m的血清甲状旁腺激素及血清磷水平明显降低，差异均有统计学意义(P < 0.05)。术后骨痛、皮肤瘙痒等临床症状明显缓解。手术成功率100%，术后并发症主要为声音嘶哑、低钙抽搐，但可恢复正常。术后用药明显减少，以补钙药物为主。结论：射频消融术治疗尿毒症难治性继发甲状旁腺功能亢进的疗效肯定，可有效降低血清甲状旁腺激素水平，缓解症状，且创伤较小，不良反应少，值得临床推广应用。

Abstract: Objective: To explore the clinical effect of ultrasound-guided percutaneous radiofrequency ablation in the treatment of uremic refractory secondary hyperparathyroidism. Methods: 30 patients with uremia secondary hyperparathyroidism were selected and treated by percutaneous radiofrequency ablation under the guidance of high frequency ultrasound. The changes of serum parathyroid hormone, serum calcium and serum phosphorus were observed before and after treatment to evaluate the clinical effect and adverse reactions. Results: 118 hyperparathyroids were ablated. Compared with that before treatment, the levels of parathyroid hormone and serum phosphorus were significantly lower on the 1 d, 3 d, 1 w, 1 m, 3 m, 6 m and 10 m after treatment (P < 0.05). The clinical symptoms such as osteodynia and pruritus were relieved obviously. The success rate of the operation was 100%. The main postoperative complications were hoarseness, hypocalcemia convulsion, but it could return to normal. Postoperative medication was significantly reduced, mainly calcium supplements. Conclusion: Radiofrequency ablation is effective in the treatment of refractory secondary hyperparathyroidism of uremia. It can effectively reduce the level of serum parathyroid hormone, relieve symptoms, and has less trauma and less adverse reactions. It is worthy of clinical application.