CAJ | 학술논문

目的：甲状旁腺全切术治疗继发性甲状旁腺功能亢进症的疗效与安全性等问题上存在争议，需要进一步探讨．方法：继发性甲状旁腺功能亢进症患者35名，均行甲状旁腺全切术，分别于术前、术中、术后1 d、1周和6个月检测患者的全段甲状旁腺激素（intact parathyroid hormone，iPTH）和血钙、血磷水平，比较患者手术前后瘙痒、骨痛等症状及生质量等方面改变，观察术后并发症，了解继发性甲旁亢的复发情况．结果：35例患者（100％）甲状旁腺病理上均有结节性增生，部分合并弥漫性增生．在35例患者中共发现138枚甲状旁腺，其中有2例（5.7％）仅有3枚甲状旁腺．术前iPTH （2152.59±937.88）pg/mL，术后7 d iPTH （14.11±14.42）pg/mL，iPTH显著性降低（P＜0.05）；术后7 d血钙水平为（1.61±0.32）mmol/L，多数患者存在手足麻木症状，但经过静脉及口服补钙治疗，低血钙症状可以控制，患者能够良好耐受，均未发生严重低血钙事件．术后患者骨痛、皮肤瘙痒等症状得到显著改善．术后随访至少6个月，无1例复发．结论：甲状旁腺全切术是治疗继发性甲状旁腺功能亢进症疗效满意且安全可靠的手术方式．
목적：갑상방선전절술치료계발성갑상방선공능항진증적료효여안전성등문제상존재쟁의，수요진일보탐토．방법：계발성갑상방선공능항진증환자35명，균행갑상방선전절술，분별우술전、술중、술후1 d、1주화6개월검측환자적전단갑상방선격소（intact parathyroid hormone，iPTH）화혈개、혈린수평，비교환자수술전후소양、골통등증상급생질량등방면개변，관찰술후병발증，료해계발성갑방항적복발정황．결과：35례환자（100％）갑상방선병리상균유결절성증생，부분합병미만성증생．재35례환자중공발현138매갑상방선，기중유2례（5.7％）부유3매갑상방선．술전iPTH （2152.59±937.88）pg/mL，술후7 d iPTH （14.11±14.42）pg/mL，iPTH현저성강저（P＜0.05）；술후7 d혈개수평위（1.61±0.32）mmol/L，다수환자존재수족마목증상，단경과정맥급구복보개치료，저혈개증상가이공제，환자능구량호내수，균미발생엄중저혈개사건．술후환자골통、피부소양등증상득도현저개선．술후수방지소6개월，무1례복발．결론：갑상방선전절술시치료계발성갑상방선공능항진증료효만의차안전가고적수술방식．
Aim:To investigate the efficacy and safety of total par-athyroidectomy (tPTX)in the treat-ment of secondary hyperparathyroidism(SHPT).Methods:Thirty-five SHPT patients treated with tPTX cases were reviewed retrospectively.Their average age was (46.8 ±8.6 )years old,and their dialysis age ranged (79.6 ±52.3)months.Biochemical parameters、iPTH and symptoms before and after opera-tion,operation complications and recurrence of SHPT were analyzed.Results:All parathyroid samples showed nodular changes on pathological examination,some samples also accompanied with diffuse prolifer-ation.138 parathyroid glands have been found in 35 cases.Only 3 parathyroid glands were found in 2 pa-tients (5.7%).The mean iPTH was (2 152.59 ±937.88)pg/mL before operation and was (14.1 1 ± 14.42)pg/mL on the 7th day after operation,the difference is significant(P<0.05).The mean blood calcium concentration was (1.61 ±0.32)mmol/L on the 7th day after operation.The most prevalent postoperation complication was hypocalcemia.All patients required oral or intravenous calcium supple-ment.No Severe hypocalcemia event was observed.Bone pain and pruritus re-lieved significantly after operation.6 months of follow-up were given,no recurrence was observed.Conclusion:tPTX is a rela-tively safe and effective method in the treatment of patients with SHPT.