摘要
目的:探讨多学科协作管理下尿毒症继发甲状旁腺功能亢进(SHPT)行甲状旁腺全切除术(TPTX)与TPTX+自体移植(AT)的对比研究。方法:通过多学科协作下对TPTX与TPTX+AT两组患者术后血钙、血磷、全段甲状旁腺激素(iPTH)、左室射血分数、两室心室结构、心脏瓣膜钙化、血钙钙化、手术时间、出血量、住院费用进行比较。结果:TPTX组复发率明显低于TPTX+AT组(P<0.05),甲状旁腺功能减退发生率TPTX+AT组低于TPTX组(P<0.05),口周麻木及抽搐发生率两组相比差异无统计学意义(P>0.05)。两组患者术后血钙、血磷及iPTH较术前均有明显下降(P<0.05),其中术后血钙及iPTH两组差异均无统计学意义(P>0.05);术后1个月至术后1年,TTPX组血磷控制明显较TPTX+AT组低(P<0.001)。两组左室射血分数随时间延长有增加趋势(P<0.05),但两组间相比差异无统计学意义(P>0.05);两组心室结构均呈下降趋势(P<0.05),但两组相比差异无统计学意义(P>0.05);两组心脏瓣膜钙化及血管钙化均无明显改变。两组住院时间差异无统计学意义(P>0.05),TPTX组的手术时间、出血量、住院费用均低于TPTX+AT组(P<0.05)。术前甲状旁腺定位B超检查准确率75%,ECT扫描准确率88.7%,同时行两种检查准确率91.1%。结论:TPTX虽然术后甲状旁腺功能减退发生率较高,但可控,而在术后复发率、手术时间、住院费用等方面低于TPTX+AT组,多学科协作在TPTX加或不加AT围手术期管理中体现出很好的优越性。
Objective:To explore the comparative study of total parathyroidectomy(TPTX)and TPTX+autotransplantation(AT)for uremic patients with secondary hyperparathyroidism(SHPT)under multidisciplinary management.Methods:through multidisciplinary collaboration,TPTX and TPTX+AT two groups of patients with postoperative blood calcium,phosphorus,iPTH,left ventricular ejection fraction,two ventricular structure,cardiac valve calcification,blood calcium calcification,operation time,blood loss,hospitalization expenses were compared.Results:The recurrence rate of TPTX group was significantly lower than that of TPTX+AT group(P<0.05);The incidence of hypoparathyroidism in TPTX+AT group was lower than that in TPTX group(P<0.05).There was no significant difference in the incidence of perioral numbness and convulsion between the two groups(P>0.05).The serum calcium,phosphorus and iPTH of the two groups were significantly decreased after operation(P<0.05),and there was no significant difference between the two groups(P>0.05);From 1 month to 1 year after operation,blood phosphorus control in TPTX group was significantly lower than that in TPTX+AT group(P<0.001).The left ventricular ejection fraction of the two groups increased with time(P<0.05),but the difference between the two groups was statistically significant(P>0.05);There was no significant difference between the two groups(P>0.05);There were no significant changes in cardiac valve calcification and vascular calcification in the two groups.There was no significant difference in the length of hospital stay between the two groups(P>0.05).The operation time,blood loss and hospitalization expenses of TPTX group were lower than those of TPTX+AT group(P<0.05).The accuracy of parathyroid localization was 75%by B-ultrasound,88.7%by ECT,and 91.1%by both methods.Conclusion:Although the incidence of postoperative hypoparathyroidism in TPTX group is high,it can be controlled,and the recurrence rate,operation time and hospitalization cost in TPTX group are lower than those in TPTX+AT group,Multidisciplinary collaboration in the perioperative management of TPTX+/-AT shows good advantages.
作者
崔恒锋
茆俊花
夏盛成
王爱坤
王立胜
CUI Heng-feng;MAO Jun-hua;XIA Sheng-cheng;WANG Ai-kun;WANG Li-sheng(Department of General Surgery,The Third People's Hospital of Yancheng City,Jiangsu Province,Yancheng 224000,China;Department of Nephrology,The Third People's Hospital of Yancheng City,Jiangsu Province,Yancheng 224000,China;Jiangsu Vocational College of Medicine,Yancheng 224000,China)
出处
《中国现代普通外科进展》
CAS
2022年第3期191-195,共5页
Chinese Journal of Current Advances in General Surgery
基金
江苏医药职业学院临床学院专项科研发展基金(20209126)。
关键词
甲状旁腺全切除术
继发性甲状旁腺功能亢进
多学科协作
围手术期
Total parathyroidectomy
Secondary hyperparathyroidism
Multidisciplinary collaboration
Perioperative period
