继发性甲状旁腺功能亢进外科治疗的疗效分析

发布时间：2018-05-24 02:47

  本文选题：继发性甲状旁腺功能亢进 + 99mTc—MIBI引导下的甲状旁腺切除术　； 参考：《上海交通大学》2015年硕士论文

【摘要】：目的:分析三种外科手术方式治疗继发性甲状旁腺功能亢进的短期及长期疗效。方法:回顾性分析自2004年10月至2014年10月于上海交通大学医学院附属仁济医院因继发性甲状旁腺功能亢进行甲状旁腺切除术的病例共88例。病例分为3组,组I行甲状旁腺次全切除术,组II行甲状旁腺全切+前臂移植术,组III行99m Tc—MIBI引导下的甲状旁腺全切+前臂移植术。收集3组病例术前、术后短期(≤6月)及术后长期(6月)的血钙、血磷、血PTH的结果及临床症状改善程度和术后复发率及并发症等资料。结果:三组术后临床症状均较术前有明显改善。组I和组II术后短期内血钙、血PTH及术后短期复发率均无统计学差异。组III术后短期内血钙、血PTH及术后短期复发率均低于组I及组II,差异有统计学意义(P0.05)。三组术后血磷值无统计学差异。组III手术时间明显短组II手术时间,差异有统计学意义(P0.05)。组III切除的甲状旁腺阳性率高于组II,差异有统计学意义(P0.05)。经过长期随访,组I与组II的术后血钙、血磷、血PTH及术后复发率均无统计学差异。组III的术后复发率均低于组I及组II的术后复发率,差异有统计学意义(P0.05)。结论:治疗继发性甲状旁腺功能亢进,甲状旁腺全切+前臂移植有着较好的疗效,而99m Tc—MIBI引导下的甲状旁腺全切+前臂移植术则可更好的发现异位及额外的甲状旁腺,提高手术成功率,同时术中可无需等待冰冻病理,缩短手术时间。在术后随访中,复发率也较低,是一种安全及有效的治疗方式。
[Abstract]:Objective: to analyze the short-term and long-term efficacy of three surgical methods in the treatment of secondary hyperparathyroidism. Methods: 88 cases of secondary hyperparathyroidism in Renji Hospital affiliated to Shanghai Jiaotong University Medical College from October 2004 to October 2014 were retrospectively analyzed. The patients were divided into 3 groups: group I underwent subtotal parathyroidectomy, group II underwent total parathyroidectomy forearm transplantation, group III underwent total parathyroid gland resection under 99m Tc-MIBI guidance. The data of serum calcium, phosphorus, PTH, clinical symptom improvement, recurrence rate and complications were collected in three groups of patients before operation, short period after operation (鈮，

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