CAJ | 학술논문

目的观察原发性和继发性甲状旁腺功能亢进患者围手术期临床特征,探讨PTH及血钙、血磷水平对于判断手术效果的意义.方法分析北京大学人民医院胃肠外科2010年8月至2013年1月收治的24例甲状旁腺功能亢进患者手术中及围手术期各项临床参数. 结果专业医师进行B超检查确定病变甲状旁腺数量的检出率为97.56％(40/41),高于其他检查方法.全部24例甲状旁腺功能亢进患者在切除病变甲状旁腺或全部甲状旁腺后ioPTH值在15 min内迅速下降,平均降至手术开始时的11％以下.在随后的72 h内,继发性甲状旁腺功能亢进患者PTH水平持续降低而原发性甲状旁腺功能亢进患者PTH在术后24h开始回升.随着PTH降低,继发性甲状旁腺功能亢进患者术后血磷水平约在术后6h左右降至正常,原发性甲状旁腺功能亢进患者术后血钙水平约在术后6h可降至正常.结论由专业医师实施的B超检查术前检出率高于其他检查方法.实施ioPTH测定是术中判断手术切除效果的重要手段,但对于继发性甲状旁腺功能亢进患者ioPTH下降至手术开始时的50％以下尚不足以判断病变甲状旁腺切除完全,需要结合术前影像学定位结果.
목적 관찰원발성화계발성갑상방선공능항진환자위수술기림상특정,탐토PTH급혈개、혈린수평대우판단수술효과적의의.방법 분석북경대학인민의원위장외과2010년8월지2013년1월수치적24례갑상방선공능항진환자수술중급위수술기각항림상삼수. 결과 전업의사진행B초검사학정병변갑상방선수량적검출솔위97.56％(40/41),고우기타검사방법.전부24례갑상방선공능항진환자재절제병변갑상방선혹전부갑상방선후ioPTH치재15 min내신속하강,평균강지수술개시시적11％이하.재수후적72 h내,계발성갑상방선공능항진환자PTH수평지속강저이원발성갑상방선공능항진환자PTH재술후24h개시회승.수착PTH강저,계발성갑상방선공능항진환자술후혈린수평약재술후6h좌우강지정상,원발성갑상방선공능항진환자술후혈개수평약재술후6h가강지정상.결론유전업의사실시적B초검사술전검출솔고우기타검사방법.실시ioPTH측정시술중판단수술절제효과적중요수단,단대우계발성갑상방선공능항진환자ioPTH하강지수술개시시적50％이하상불족이판단병변갑상방선절제완전,수요결합술전영상학정위결과.
Objective To evaluate clinical features of primary and secondary hyperparathyroidism in perioperative period in term of the changes of PTH level,blood calcium and blood phosphates as a judge of the effect.Methods Clinical data of 24 hyperparathyroidism cases admitted from August 2010 to January 2013 to the Department of Gastrointestinal Surgery,Peking University People's Hospital were retrospectively analyzed.Results The lesion detect rate performed by the professional B ultrasound examiners was 97.56％ (40/41).The ioPTH value in all 24 cases decreased rapidly within 15 minutes after parathyroidectomy to 11％ at average compared to those at the beginning of operation.In the next 72 hours,PTH level continuously decreased in the secondary hyperparathyroidism patients,however,began to rise in 24 hours after the operation in the primary hyperparathyroidism patients.With the decrease of PTH,the blood phosphates level in the secondary hyperparathyroidism patients went into normal range in about 6 hours after operation,blood calcium level dropped to normal range in about 6 hours postoperatively in primary hyperparathyroidism patients.Conclusions The lesion determination rate of B ultrasound performed by professional examiners is higher than that of other examination methods.ioPTH measurement is an important means to judge the effect of surgical resection in the operation,but in cases of secondary hyperparathyroidism 50％ decrease of original ioPTH value is enough to judge complete parathyroidectomy only in combination with preoperative imaging results.