难治性继发性甲状旁腺功能亢进手术治疗和口服拟钙剂治疗的短期疗效对比

发布时间：2018-06-11 17:17

本文选题：继发性甲状旁腺功能亢进 + 甲状旁腺全切除术　；参考：《新疆医科大学》2017年硕士论文

【摘要】：目的:1.了解单纯骨化三醇冲击治疗难治性继发性甲状旁腺功能亢进(Secondary hyperparathyroidism SHPT)患者6个月的钙、磷、全段甲状旁腺激素(intact parathyroid hormone iPTH)、钙磷乘积、治疗后症状的改善,并发症的状况。2.了解甲状旁腺全切术(total parathyroidectomy t-PTX)治疗难治性SHPT患者6个月的钙、磷、iPTH、钙磷乘积、术后症状的改善,并发症及复发率的状况。3.了解口服拟钙剂治疗难治性SHPT患者6个月的钙、磷、iPTH、钙磷乘积、治疗后症状的改善,并发症的状况。4.对比t-PTX、口服拟钙剂与单纯骨化三醇冲击治疗难治性SHPT患者6个月的钙、磷、iPTH、钙磷乘积、术后症状的改善,并发症及复发率的状况。评估三组的短期疗效。5.通过疗效对比,来指导难治性SHPT的治疗。方法:对2012年1月至2015年9月我院收治的118例难治性SHPT患者,118例难治性SHPT患者均进行常规内科治疗,包括低磷饮食、充分的血液透析或腹膜透析、规律注射促红素和降压等对症支持治疗。其中62例难治性SHPT患者在常规内科治疗的基础上行单纯骨化三醇冲击治疗为A组;26例难治性SHPT患者在常规内科治疗的基础上行t-PTX治疗为B组;30例难治性SHPT患者在常规内科治疗的基础上口服拟钙剂治疗为C组。对以上患者临床资料进行回顾性分析。三组患者均完成治疗前、第1天、第1月、第3月、第6月的钙、磷、钙磷乘积、iPTH、术后症状的改善、并发症及术后复发率的随访。结果:1.62例难治性SHPT患者行单纯骨化三醇冲击治疗第1天、第1月、第3月、第6月的钙、磷、全段甲状旁腺激素、钙磷乘积与治疗前五统计学差异。治疗后1月内症状改善率为25.80%,1月内症状改善率为24.19%,3月内症状改善率为12.90%,6月内症状改善率为3.22%。6月内发生2例自发性骨折和1例泌尿系结石病人。2.26例难治性SHPT患者在常规内科治疗的基础上行t-PTX治疗第1天、第1月、第3月、第6月的磷、全段甲状旁腺激素、钙磷乘积与术前有统计学差异;治疗后第1月、第3月、第6月的钙与术前有统计学差异;治疗后第1天的钙与术前无统计学差异。治疗后1月内症状改善率为96.15%,1月内症状改善率为96.15%,3月内症状改善率为92.30%,6月内症状改善率为92.30%。术后1月内有2例患者出现明显的手足麻木症状,无其他并发症。6月内有1例复发,复发率为3.84%。3.30例难治性SHPT患者在常规内科治疗的基础上口服拟钙剂治疗第1天、第1月、第3月、第6月的钙、磷、全段甲状旁腺激素、钙磷乘积与术前有统计学差异。治疗后1月内症状改善率为86.67%,1月内症状改善率为83.33%,3月内症状改善率为66.67%,6月内症状改善率为60.00%。术后6月内有2例患者出现明显的手足麻木症状,无其他并发症。4.B组和C组较A组钙磷乘积点磷、钙磷乘积、血清全段甲状旁腺激素(intact parathyroid hormone iPTH)均显著降低(P0.05)。C组与A组治疗后各时点钙比较无统计学意义(P0.05)。B组与A组治疗后各时点钙比较均显著降低,有统计学意义(P.05)。B组与C组治疗后各时点钙、磷、钙磷乘积、iPTH均显著降低,有统计学意义(P0.05)。结论:单纯骨化三醇冲击治疗难治性SHPT患者无明显优势。1行t-PTX时治疗难治性SHPT患者的首选、有效方式。2.口服拟钙剂治疗为难治性SHPT患者提供了非手术治疗的可能。3.仍需长期随访,观察长期疗效。
[Abstract]:Objective: 1. to understand the 6 months of calcium, phosphorus, total parathyroid hormone (intact parathyroid hormone iPTH), calcium and phosphorus product (intact parathyroid hormone iPTH), the improvement of the symptoms after treatment, and the status of the complications (total P) (total P) for patients with refractory secondary hyperparathyroidism (Secondary hyperparathyroidism SHPT). Arathyroidectomy t-PTX) treatment of refractory SHPT patients for 6 months of calcium, phosphorus, iPTH, calcium and phosphorus products, improvement of postoperative symptoms, complications and recurrence rates,.3. to understand the calcium, phosphorus, iPTH, calcium and phosphorus products of refractory SHPT patients for 6 months in treatment of refractory SHPT patients, improvement of postoperative symptoms, complications of.4. contrast t-PTX, oral calcium agent and oral administration of calcium Simple ossification three alcohol shock treatment for refractory SHPT patients 6 months of calcium, phosphorus, iPTH, calcium and phosphorus product, postoperative symptoms improvement, complications and recurrence rates. Evaluate the short-term efficacy of three groups.5. through the curative effect comparison, to guide the treatment of refractory SHPT. Methods: 118 cases of refractory SHPT patients admitted to our hospital from January 2012 to September 2015, 118 Cases of refractory SHPT patients were treated with routine medical treatment, including low phosphorus diet, adequate hemodialysis or peritoneal dialysis, regular injection of erythropoietin and antihypertensive therapy. 62 patients with refractory SHPT were treated with simple ossification and three alcohol shock therapy on the basis of routine internal medicine treatment, and 26 cases of refractory SHPT patients were in the routine. 30 patients with refractory SHPT were treated as group B, and 30 patients with refractory SHPT were treated in group C on the basis of routine medical treatment. The clinical data of the patients were analyzed retrospectively. The three groups were completed before treatment, first days, first months, third months, sixth months of calcium, phosphorus, calcium and phosphorus products, iPTH, postoperative symptoms improved, complicated, Results: 1.62 cases of refractory SHPT patients were treated with simple ossification of three alcohol shock for first days, first months, third months, sixth months of calcium, phosphorus, total parathyroid hormone, calcium and phosphorus product and five before treatment. The improvement rate of symptoms in January was 25.80%, the symptom improvement rate was 24.19% in January, and the symptoms were improved in March. The rate of improvement was 12.90% in June. In June, the improvement rate was 2 cases of spontaneous fracture in 3.22%.6 months and 1 cases of urinary calculi in.2.26 patients. T-PTX treatment was performed on the basis of routine internal medicine treatment. First months, third months, sixth months of phosphorus, total parathyroid hormone, calcium and phosphorus product were statistically different from preoperative, and first months after treatment, Third months, sixth months of calcium and preoperative statistically significant difference, first days after the treatment of calcium and no statistical difference before the treatment. After the treatment in January, the symptom improvement rate was 96.15%, the symptom improvement rate in January was 96.15%, the symptom improvement rate was 92.30% in March, and in June, the symptom improvement rate was 92.30%. in January, there were 2 patients with obvious numbness of hand and foot. The recurrence rate was 1 cases in.6 months, and the recurrence rate was 3.84%.3.30 cases of refractory SHPT patients on the basis of routine medical treatment for first days, first months, third months, sixth months of calcium, phosphorus, total parathyroid hormone, calcium and phosphorus product and preoperative statistical difference. After treatment, the improvement rate of symptoms in January was 86.67%, and the symptoms changed in January. The good rate was 83.33%, the symptom improvement rate in March was 66.67%. In June, the symptom improvement rate was 2 cases in June. There were 2 patients with obvious sign of hand and foot numbness, no other complications in group.4.B and C group were compared with A group calcium phosphorus product point phosphorus, calcium phosphorus product, and serum total parathyroid hormone (intact parathyroid hormone iPTH) significantly decreased (P0.05).C. The calcium comparison of group.B and group A was not statistically significant (P0.05) in group.B and group A after treatment, the calcium comparison of each time point was significantly decreased. There was statistical significance (P.05) in group.B and group C after treatment, calcium, phosphorus, calcium and phosphorus products, iPTH were significantly reduced, and statistically significant (P0.05). Conclusion: simple ossification of three alcohol shock treatment of refractory SHPT patients The first choice for the treatment of refractory SHPT patients when the obvious advantage of.1 t-PTX is to treat patients with refractory SHPT. The effective way of.2. oral calcium preparation is to provide non operative treatment for refractory SHPT patients. The long-term follow-up is still needed and the long-term effect is observed.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5;R653

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