全胃切除术后继发严重代谢性骨病5例

摘要

目的：探讨全胃切除术（ total gastrectomy， TGX）后继发严重代谢性骨病的临床表现、检查结果、治疗及预防措施。方法对我院2003年－2013年普外科、骨科、风湿科收治的5例全胃切除术后继发严重代谢性骨病患者的临床表现、检查结果和治疗、随访结果进行分析。结果5例患者均表现为严重代谢性骨病症状，出现骨痛、骨折，骨密度下降，血钙降低，血磷偏低；1例存在严重低钙血症，有搐搦表现；3例合并较重的营养不良。经补充钙、活性维生素D3制剂和注射唑来膦酸后症状明显缓解。随访显示患者病情缓慢发展。结论全胃切除术后继发严重代谢性骨病值得重视，合理的补充钙剂和活性维生素D3制剂有效。疾病的发展较难逆转，故术后及时预防、复查非常重要。%Objective To explore clinical characteristics, examination, therapy, and preventive measure in severe metabolic bone disease ( MBD) after total gastrectomy ( TGX) .Methods The clinical characteristics, examination, therapy, and following-up of five patients with severe metabolic bone disease after TGX in the department of surgery, orthopedics, and rheumatology from 2003 to 2013 were analyzed.Results All five patients were found to have severe symptom of MBD, with bone pain and fracture, decreased bone mineral density, hypocalcemia, and decreased phosphoremia.One patient showed severe hypocalcemia with tetany. Three patients showed moderate malnutrition.Oral administration of calcium, active vitamin D3 , and intravenous zoledronic acid led to remarkable relieving for all patients.Following-up showed slowly advance of the disease in the patients.Conclusion More attention should been paid in patients with MBD after TGX.Calcium and active vitamin D3 supplement are effective.This severe complication is hard to reverse.Therefore prompt prevention and following-up are very important.