目的探讨甲状旁腺全切除术并自体前臂移植5颗甲状旁腺组织颗粒(1 mm×1 mm×1 mm)(TPTX+AT)治疗尿毒症继发甲状旁腺功能亢进症(SHPT)的疗效和可行性.方法选择该院2016-012017-12的尿毒症SHPT患者,行甲状旁腺全切除术并自体前臂移植5颗甲状旁腺组织颗粒,观察患者术后甲状旁腺激素(i PTH)和血钙等生化指标变化情况、症状缓解情况、平均住院时间、并发症及复发情况.结果共纳入13例患者进行了TPTX+AT手术治疗.全部患者无术中喉返神经损伤,术后第1天i PTH均降至正常水平,术后1周、3个月、6个月、12个月的i PTH水平较术前均显著降低(P＜0.05),且均在正常值范围内,无复发病例.骨痛、皮肤瘙痒等症状在术后1周内均缓解或消失,术后骨骼变形、身高缩短等症状均改善或未继续进展.结论TPTX+AT安全有效可行,保留了甲状旁腺功能的同时控制了术后复发情况,可能是治疗SHPT的更优术式.%Objective To investigate the effects of total parathyroidectomy with improved autotransplantation (TPTX+AT) of 5 autologous parathyroid tissue pieces (each one 1 mm×1 mm×1 mm) on secondary hyperparathyroidism (SHPT) to uremia.Methods The patients with SHPT to uremia were selected from January 2016 to December 2017, and 5 autologous parathyroid tissue pieces (each one 1 mm×1 mm×1 mm) were transplanted into the patients'healthy forearms after total parathyroid thyroidectomy.The serum levels of total parathyroid hormone (i PTH), serum calcium and phosphorus, relief of symptoms of SHPT, operative complications, postoperative hospitalization time and postoperative recurrence rate were observed.Results Thirteen patients underwent this procedure (TPTX+AT).All the patients had no intraoperative laryngeal nerve injury.On the first day after operation, i PTH was reduced to normal level in all the patients.At 1 week, 3 months, 6 months and 12 months after operation, the serum i PTHs were significantly decreased compared with those before operation (P＜0.05).And all these postoperative indicators were within the normal ranges, with no recurrence cases.The symptoms of bone pain and pruritus were relieved or disappeared within one week, and the symptoms of bone deformation and height shortening were improved or did not progress.Conclusion TPTX+AT is a safe, effective and better method for the treatment of SHPT to uremia.It can preserve the parathyroid function and control the postoperative recurrence of hyperparathyroidism.
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