慢性肾衰竭继发性甲状旁腺功能亢进患者行甲状旁腺全切加前臂移植术的临床分析

Clinical Analysis of Total Parathyroidectomy and Forearm Transplantation in Patients with Secondary Hyperparathyroidism in Chronic Renal Failure

摘要: 目的：分析慢性肾衰竭继发性甲状旁腺功能亢进患者(SHPT)行甲状旁腺全切除(PTX)加前臂移植术的疗效。方法：回顾性分析2013年~2019年间青岛大学附属医院肾病科收治的慢性肾衰竭SHPT行PTX加前臂移植术的37例患者的临床资料。收集患者术前术后血清全段甲状旁腺激素(iPTH)及生化指标，记录患者临床症状缓解情况，术后并发症以及复发情况。结果：37例患者中，男性22例，女性15例，平均年龄52.11 ± 1.76岁，均行血液透析，平均透析时长86.59 ± 6.03月。术前33例有肌肉无力，31例有皮肤瘙痒，28例有骨痛，6例存在骨折或畸形，3例有明显的身高缩小，24例有骨外钙化，其中1例为巨大软组织钙化，15 cm × 20 cm。术前iPTH 2039.30 ± 160.29 ng/L，术后1月iPTH 63.49 ± 16.41 ng/L，P < 0.001，差异有统计学意义。术后患者的iPTH及血钙、血磷、碱性磷酸酶均较术前改善，差异显著。且患者术后皮肤瘙痒及骨痛症状大部分得到缓解。结论：PTX加前臂移植术是治疗慢性肾衰竭SHPT安全有效的手段之一，对于内科治疗失败的难治性SHPT患者应尽早行手术治疗。

Abstract: Objective: To analyze the effect of total parathyroidectomy (PTX) plus forearm transplantation in patients with chronic renal failure secondary hyperparathyroidism (SHPT). Methods: Retrospective analysis was performed on the clinical data of 37 patients with SHPT receiving PTX plus forearm transplantation in the Department of Nephrology, Affiliated Hospital of Qingdao University from 2013 to 2019. The preoperative and postoperative serum complete parathyroid hormone (iPTH) and biochemical indexes were collected to record the remission of clinical symptoms, postoperative complications and recurrence of the patients. Results: Among the 37 patients, 22 were male and 15 were female, with an average age of 52.11 ± 1.76 years. All patients underwent hemodialysis for an average length of 86.59 ± 6.03 months. Before surgery, 33 patients had muscle weakness, 31 had itchy skin, 28 had bone pain, 6 had fractures or deformities, 3 had significant height reduction, and 24 had extra-osseous calcification, including 1 case of massive soft tissue calcification (15 cm × 20 cm). IPTH 2039.30 ± 160.29 ng/L before surgery, iPTH 63.49 ± 16.41 ng/L 1 month after surgery, P < 0.001, the difference was statistically significant. The iPTH, blood calcium, blood phosphorus and alkaline phosphatase of the postoperative patients were improved significantly compared with those before the operation. The symptoms of itchy skin and bone pain were mostly relieved after operation. Conclusion: PTX plus forearm transplantation is one of the safe and effective methods to treat SHPT in chronic renal failure. For refractory SHPT patients with medical treatment failure, surgical treatment should be performed as soon as possible.