切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2020, Vol. 14 ›› Issue (06) : 620 -623. doi: 10.3877/cma.j.issn.1674-3946.2020.06.024

所属专题: 经典病例 经典病例 文献

论著

16例继发性甲状旁腺功能亢进患者行甲状旁腺切除术后复发再次手术的临床分析
陈会1, 康鸿斌2, 陈娟2,()   
  1. 1. 230000 安徽医科大学第二附属医院
    2. 010050 内蒙古医科大学附属医院
  • 收稿日期:2020-03-03 出版日期:2020-12-26
  • 通信作者: 陈娟

Re-operation after parathyroidectomy for the recurrence of the secondary hyperparathyroidism, clinical analysis of 16 cases

Hui Chen1, Hongbin Kang2, Juan Chen2,()   

  1. 1. The Second Affiliated Hospital of Anhui Medical University, Anhui 230000, China
    2. The Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia 010050, China
  • Received:2020-03-03 Published:2020-12-26
  • Corresponding author: Juan Chen
  • About author:
    Corresponding author: Chen Juan, Email:
  • Supported by:
    Project of Inner Mongolia Autonomous Region Health and Family Planning Commission(2017MS01123)
引用本文:

陈会, 康鸿斌, 陈娟. 16例继发性甲状旁腺功能亢进患者行甲状旁腺切除术后复发再次手术的临床分析[J/OL]. 中华普外科手术学杂志(电子版), 2020, 14(06): 620-623.

Hui Chen, Hongbin Kang, Juan Chen. Re-operation after parathyroidectomy for the recurrence of the secondary hyperparathyroidism, clinical analysis of 16 cases[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(06): 620-623.

目的

分析16例继发性甲状旁腺功能亢进(SHPT)患者行甲状旁腺切除术后复发再次手术的临床应用效果。

方法

回顾性分析2017年5月至2019年10月接受再次手术的16例SHPT行甲状旁腺切除术后复发患者临床资料,采用SPSS22.0软件进行数据处理,甲状旁腺体积、实验室指标、生存质量(WHOQOL-BREF)以(±s)表示,采用配对样本t检验;手术成功率、症状改善情况及并发症采用χ2检验,P<0.05为差异有统计学意义。

结果

16例患者手术成功15例,手术成功率为93.75%;相比术前,患者术后6个月的皮肤瘙痒、骨痛、骨折或骨骼畸形、肌无力伴萎缩及异位钙化发生率较低,甲状旁腺体积、血清全段甲状旁腺激素(iPTH)、血钙(Ca)及磷(P)水平均较低,WHOQOL-BREF各维度评分均较高,差异有统计学意义(P<0.05);16例患者均未见手脚抽搐、术区出血、呼吸困难及骨饥饿综合征等并发症,5例出现低钙血症,1例出现短暂性进食呛咳。

结论

针对甲状旁腺切除术后复发的SHPT再次手术治疗的成功率高、并发症少,可促进临床症状改善及消失,降低血清iPTH水平,避免遗留甲状旁腺,改善生活质量。

Objective

To analyze the clinical outcome of reoperation after parathyroidectomy for the recurrence of the secondary hyperparathyroidism in 16 patients.

Methods

The clinical data of 16 patients with recurrent secondary hyperparathyroidism after parathyroidectomy, who underwent reoperation from May 2017 to October 2019, were analyzed retrospectively. Statistical analysis were performed by using SPSS 22.0 software. Measurement data, such as Parathyroid volume, laboratory parameters, and quality of WHOQOL-BREF were expressed as (±s), and were examined by using paired sample t test. Surgical success rate, symptom improvement and postoperative complications were analyzed by using χ2 test A P value <0.05 was considered as statistically significant difference.

Results

15 of 16 patients (93.75%) received successful surgery. Compared with the preoperative period, patients' complains of skin pruritus, bone pain, fracture or bone deformity, muscle weakness with atrophy and ectopic calcification was much lower at 6 months after operation. Blood calcium (Ca) and phosphorus (P) levels are low, WHOQOL-BREF scores are high in all dimensions, with significant difference (P<0.05). There were no complications of hand and foot twitching, bleeding in the operation area, dyspnea and bone hunger syndrome in 16 patients. Hypocalcemia occurred in 5 cases, while short-term eating cough occurred in 1 case.

Conclusion

For the recurrence of secondary hyperparathyroidism after parathyroidectomy, the success rate of reoperation is pretty good with low complications, which could promote the improvement and disappearance of clinical symptoms, including reducing the serum iPTH level, avoiding the residual parathyroid glands, with improved life quality.

表1 16例SHPT患者术后复发再手术患者症状改善情况分析[例(%)]
表2 16例SHPT患者术后复发再手术患者术前术后实验室指标分析(±s)
表3 16例SHPT患者术后复发再手术患者术前术后WHOQOL-BREF量表评分[(±s),分]
[1]
易国华,刘宜翔,朱洪波.全甲状旁腺切除术联合自体移植治疗尿毒症继发性甲状旁腺功能亢进症的临床分析[J].实用临床医药杂志,2018, 22(11): 91-94.
[2]
郝国强,邢壮杰,邓芝徽,等.继发性甲状旁腺功能亢进行甲状旁腺全切除术后低钙血症的防治[J].安徽医药,2019, 23(10): 1998-2000.
[3]
Best CAE, Krishnan R, Malvankar-Mehta MS,et al.Echocardiogram changes following parathyroidectomy for primary hyperparathyroidism: A systematic review and meta-analysis[J]. Medicine,2017, 96(43): e7255.
[4]
Yang PS, Liu CL, Liu, TP,et al.Parathyroidectomy decreases neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios[J].J Surg Res, 2018, 224: 169-175.
[5]
金昌国,易文,艾向南,等.腔镜甲状旁腺切除术在甲状旁腺功能亢进中的应用[J].中国急救复苏与灾害医学杂志,2018, 13(7): 652-655.
[6]
王玉芹,葛益飞,毛慧娟.继发性甲状旁腺功能亢进症57例手术治疗临床分析[J].重庆医学,2017, 46(18): 2478-2480.
[7]
中华医学会内分泌学分会《中国甲状腺疾病诊治指南》编写组.中国甲状腺疾病诊治指南-甲状腺功能亢进症[J].中华内科杂志,2007, 46(10): 876-882.
[8]
胡亚,花苏榕,王梦一,等.可避免的原发性甲状旁腺功能亢进症再次手术临床分析[J].中华外科杂志,2017, 55(8): 582-586.
[9]
花瞻,张凌,李程,等.继发性甲状旁腺功能亢进症的再手术临床分析[J].中华外科杂志,2018, 56(6): 442-446.
[10]
Anderson K, Ruel E, Adam MA,et al. Subtotal vs. total parathyroidectomy with autotransplantation for patients with renal hyperparathyroidism have similar outcomes[J]. Am J Surg,2017, 214(5): 914-919.
[11]
李会政,刘琳,张颖.继发性甲状旁腺功能亢进不同手术方式的疗效分析[J].中国耳鼻咽喉头颈外科,2019, 26(2): 59-62.
[12]
端靓靓,刘伟,施杰,等.甲状旁腺切除术治疗尿毒症继发性甲状旁腺功能亢进症52例临床观察[J].医学综述,2019, 25(16): 3299-3303.
[13]
余文洪,孙岩,卓燕.尿毒症患者继发甲状旁腺功能亢进合并甲状腺癌的临床特点及诊治[J].重庆医学,2017, 46(25): 3589-3590.
[14]
孔令泉,邹宝山,李浩,等.肾性继发性甲状旁腺功能亢进患者甲状旁腺切除术后并发甲状腺毒症的防治[J].中华内分泌外科杂志,2019, 13(4): 265-268.
[15]
安宏,庞毅,徐辉.慢性肾脏病继发甲状旁腺功能亢进的手术治疗[J].天津医药,2018, 46(12): 1357-1362.
[16]
张敏,周蕾.三种甲状腺全切除术式的临床疗效及对甲状旁腺功能的影响对比[J/CD].中华普外科手术学杂志(电子版),2018, 12(3): 261-264.
[17]
周鹏,贺青卿,庄大勇,等.持续性和复发性肾性甲状旁腺功能亢进的外科治疗[J].中华普通外科杂志,2019, 34(9): 766-770.
[18]
陈安举,徐先发.术中甲状旁腺激素测定在甲状旁腺切除中应用[J].国际耳鼻咽喉头颈外科杂志,2019, 43(1): 23-26, 31.
[19]
高恒元,许楠,罗勋鹏,等.72例继发性甲状旁腺功能亢进行甲状旁腺次全切除术的治疗分析[J].中国现代普通外科进展,2017, 20(9): 684-686, 691.
[20]
李培坤,余忠山,谢胜学,等.腔镜下甲状旁腺全切联合自体移植治疗肾性甲状旁腺功能亢进[J].中华普通外科杂志,2019, 34(6): 530-531.
[1] 郭艳波, 马亮, 李刚, 阎伟, 骆帝, 岳亮, 吴伟山. 全膝关节置换术后胫股关节脱位的研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 658-671.
[2] 陈翠萍, 李佩君, 杜景榕, 谢青梅, 许一宁, 卓姝妤, 李晓芳. 互联网联合上门护理在老年全髋关节置换术后的应用效果[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 676-681.
[3] 王伟伟, 费建平, 王璋瑜. 不同手术空间建立方法的经口腔前庭入路腔镜甲状腺术对比研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 84-87.
[4] 顾雯, 凌守鑫, 唐海利, 甘雪梅. 两种不同手术入路在甲状腺乳头状癌患者开放性根治性术中的应用比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 687-690.
[5] 何羽. 腔镜微创手术治疗分化型甲状腺癌的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 456-458.
[6] 宋红霞, 吴玩呈. 内镜下甲状腺手术切口入路发展的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 470-472.
[7] 李萍, 陈慧, 庄君龙. 快速康复外科在机器人辅助腹腔镜膀胱切除回肠造口术中的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(03): 249-253.
[8] 刘欣茹, 杜鹃, 代健健, 辛秀娟, 高梨梨. SBAR沟通模式在急诊腹股沟疝手术患者中的应用研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(04): 451-455.
[9] 孙红燕, 李娟. 造口旁疝患者生活质量的影响因素分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 273-276.
[10] 张璇, 高杨, 房雅君, 姚艳玲. 保护性机械通气在肺癌胸腔镜肺段切除术中的临床应用[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 563-567.
[11] 马锦芳, 何正光, 郑劲平. 盐酸氨溴索雾化吸入治疗慢性阻塞性肺疾病黏痰症患者的疗效和安全性分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 568-574.
[12] 陶银花, 张红杰, 王亚岚, 陈莲, 张珺. 间歇式气压治疗预防肺癌化疗下肢深静脉血栓的临床分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 605-608.
[13] 林建琴, 孔令敏, 陆银凤, 陈勇, 金凤, 叶磊, 陈方梅. PERMA模式对肺癌患者治疗获益感及生活质量的影响分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 634-638.
[14] 罗孝平, 封敏, 黄川, 唐茜, 蒋艳, 胡莉丽. 渐进式抗阻训练干预在非小细胞肺癌中的临床应用[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(03): 472-474.
[15] 赵磊, 刘文志, 林峰, 于剑, 孙铭骏, 崔佑刚, 张旭, 衣宇鹏, 于宝胜, 冯宁. 深部热疗在改善结直肠癌术后辅助化疗副反应及生活质量中的作用研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 488-493.
阅读次数
全文


摘要