Objective To discuss the clinical effect of ultrasound-guided percutaneous ethanol injection in the treatment of refractory secondary hyperparathyroidism ( SHPT ) .Methods Total of 56 patients with refractory SHPT admitted to the First Affiliated Hospital of Xi′an Jiaotong University from Dec.2011 to Dec. 2013 were included in the study,and divided into the observation group of 28 cases and control group of 28 cases according to random number table method.The observation group was treated by injection of anhydrous alcohol under ultrasound guidance,while the control group was treated by surgery.serological indicators were observed and compared between the two groups before treatment and 1 day,1 week,1 month and 6 months after treatment, the symptom remission time was observed,and the findings of color Doppler ultrasound and complications during follow-up were observed and analyzed.Results One week,one month after treatment, the intact parathyroid hormone(iPTH),Ca2+,P3-index of the two groups showed a downward trend,six months after treatment increased,the difference was statistically significant(P<0.05);alkaline phosphatase ( ALP) levels of patients in the observation group one week,one month after treatment decreased and after six months of treatment increased(P<0.05);one week,one month and six months after treatment in the control group,ALP levels presented downward trend ( P <0.05 );iPTH, Ca2+, P3-of patients in the observation group one week,one month and six months after treatment were significantly higher(P<0.05),but ALP lev-els one week and one month after treatment were lower than the control group ,six months after treatment was higher than the control group(P<0.05).The proportion of patients with bone pain and muscle weakness in the observation group one week after treatment was significantly higher than the control group ( P<0.05 );the proportion of pruritus,bone pain,muscle weakness after six months of the observation group were signifi-cantly higher than the control group,the differences were statistically significant (P <0.05).Ultrasound examination results and adverse events of the two groups were not statistically significantly different ( P >0.05).Conclusion Percutaneous ethanol injection therapy and operation under ultrasound guidance both have a certain effect for patients with SHPT ,but the effect of operation is more ideal and with good safety pro-file,besides, ethanol treatment has a higher recurrence rate, but can be used as an adjuvant therapy after operation.%目的 探讨超声引导下无水乙醇注射治疗难治性继发性甲状旁腺功能亢进( SHPT)的临床疗效. 方法 选择2011年12月至2013 年12 月西安交通大学医学院第一附属医院收治的56 例难治性SHPT患者为研究对象,采用随机数字表法分为观察组和对照组,各28 例. 观察组患者采用超声引导下进行无水乙醇注射治疗,对照组患者采用手术治疗. 对比观察两组患者治疗前、治疗后1周、1个月及6个月时的血清学指标,同时观察患者的症状缓解时间,并对随访中彩色多普勒超声检查结果及并发症情况进行观察分析. 结果 治疗后1 周、1 个月,两组患者全段甲状旁腺激素(iPTH)、Ca2+、P3-指标均呈下降趋势,治疗后6 个月又有所升高,差异有统计学意义(P<0.05);观察组患者治疗后1周、1 个月碱性磷酸酶( ALP )水平呈下降趋势,治疗后6 个月又有所升高( P <0.05);对照组治疗后1周、1个月及6个月后的ALP水平呈下降趋势(P<0.05);观察组患者治疗后1周、1个月及6个月后的iPTH、Ca2+、P3-均显著高于对照组( P <0.05 ) ,而术后1 周及术后1 个月的ALP水平低于对照组,术后6个月高于对照组( P<0.05 ). 观察组患者术后1 周的骨痛及肌无力的比例显著高于对照组( P<0.05 );术后6个月观察组患者的皮肤瘙痒、骨痛、肌无力的比例均显著高于对照组,差异有统计学意义( P<0.05 ). 两组患者的彩色多普勒超声检查结果及不良反应发生情况比较差异均无统计学意义( P>0.05 ). 结论 超声引导下的无水乙醇注射治疗与手术治疗对SHPT患者均有一定的效果,但手术治疗效果更理想,同时具有一定的安全性,可作为切除术后的辅助治疗方案.
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