腔镜下甲状旁腺全切联合部分甲状旁腺组织前臂移植治疗继发性甲状旁腺亢进

摘要

Objective To investigate the safety and feasibility of endoscopic total parathyroidectomy (ETP) combined with parathyroid tissue autotransplantation ( PTA ) in the forearm for the treatment of secondary hyperparathyroidism ( SHPT). Methods Totally 72 patients suffering from SHPT underwent ETP + PTA via the anterior chest approach from June 2004 to June 2009 in our hospital. A total of 20 pieces of healthy parathyroid tissues (1 to 1.5 mm3 in volume) were implanted into the forearms of the patients.Results The operations were performed successfully and no surgery-related mortality occurred in 71 of the patients. The mean operation time was 119.9 min (85 -155 min) , intraoperative blood loss 39.7 ml( 10 -60 ml), ambulatory care 1.2 d(0.5 -2.0 d)and hospital stay 4.7 d (3 - 8 d ). One case was converted to open surgery due to intraoperative bleeding; she suffered from postoperative hoarseness afterwards, which was then alleviated by conservative treatments. Clinical symptoms and postoperative levels of serum PTH and alkaline phosphatase, hyperphosphatemia and hypercalcemia were improved or normalized in most of the patients.Follow-up was carried out on 72 cases for ten months to five years ( mean,3.8 years). Recurrence was observed in 2 cases which were then cured by second operation. Conclusions ETP + PTA is a safe option for the treatment of SHPT with satisfying efficacy.%目的 探讨腔镜下甲状旁腺全切(endoscopic total parathyroidectomy,ETP)联合部分甲状旁腺组织前臂移植(parathyroid tissue autotransplantation,PTA)治疗继发性甲状旁腺亢进(secondary hyperparathyroidism,SHPT)的安全性、可行性.方法 2004年6月～2009年6月72例SHPT经胸前路径行腔镜下全部甲状旁腺切除,同时将20枚1～1.5 mm3大小的健康甲状旁腺组织移植于患者前臂肌膜下.结果 71例ETP联合PTA顺利完成,无术中及围手术期死亡.手术时间平均119.9 min(85～155 min),术中出血量平均39.7 ml(10～60 ml),下床时间平均1.2 d(0.5～2.0 d),住院时间平均4.7 d(3～8 d).1例因术中出血中转开放手术,术后发现声音嘶哑,经保守治疗后缓解.术后临床症状明显改善,生化检查(甲状旁腺激素、碱性磷酸酶、血钙、血磷等指标)恢复正常或明显改善.72例随访10个月～5年,平均3.8年,2例术后甲状旁腺亢进症状复发,二次手术后痊愈.结论 ETP联合PTA治疗SHPT安全、可行,疗效满意.