中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2015年
8期
661-667
,共7页
冯嘉麟%周秦毅%陈隽%罗琰文%王家东
馮嘉麟%週秦毅%陳雋%囉琰文%王傢東
풍가린%주진의%진준%라염문%왕가동
甲状旁腺功能亢进症,继发性%甲状旁腺切除术%99m锝甲氧基异丁基异腈%治疗结果
甲狀徬腺功能亢進癥,繼髮性%甲狀徬腺切除術%99m锝甲氧基異丁基異腈%治療結果
갑상방선공능항진증,계발성%갑상방선절제술%99m득갑양기이정기이정%치료결과
Hyperparathyroidism,secondary%Parathyroidectomy%Technetium Tc 99m sestamibi%Treatment outcome
目的 分析3种外科手术方式治疗继发性甲状旁腺功能亢进的短期及长期疗效.方法 回顾性分析自2004年10月至2014年10月于上海交通大学医学院附属仁济医院因继发性甲状旁腺功能亢进行甲状旁腺切除的病例共88例.病例分为3组,组Ⅰ行甲状旁腺次全切除术,组Ⅱ行甲状旁腺全切+前臂移植术,组Ⅲ行99锝标记的甲氧基异丁基异腈(99Tcm-MIBI)引导下的甲状旁腺全切+前臂移植术.收集3组病例术前、术后短期(≤6个月)及术后长期(＞6个月)的血钙、血磷、血甲状旁腺素(PTH)的结果及临床症状改善程度和术后复发率及并发症等资料.结果 3组术后临床症状均较术前有明显改善.组Ⅰ和组Ⅱ术后短期内血钙、血PTH及术后短期复发率差异均无统计学意义.组Ⅲ术后短期内血钙、血PTH及术后短期复发率均低于组Ⅰ及组Ⅱ,差异均有统计学意义(P值均＜0.05).3组术后血磷值差异无统计学意义.组Ⅲ手术时间明显短于组Ⅱ,差异有统计学意义[(77±13) min比(108±17) min,P＜0.05].组Ⅲ切除的甲状旁腺阳性率高于组Ⅱ,差异有统计学意义(98.5％比88.7％,P＜0.05).经过长期随访,组Ⅰ与组Ⅱ的术后血钙、血磷、血PTH及术后复发率差异均无统计学意义.组Ⅲ的术后复发率均低于组Ⅰ及组Ⅱ的术后复发率,差异均有统计学意义(3.6％比31.6％、21.4％,P值均＜0.05).结论 治疗继发性甲状旁腺功能亢进,甲状旁腺全切+前臂移植有着较好的疗效,而99Tcm-MIBI引导下的甲状旁腺全切+前臂移植术则可更好的发现异位及额外的甲状旁腺,提高手术成功率,同时术中可无需等待冰冻病理,缩短手术时间.在术后随访中,复发率也较低,是一种安全及有效的治疗方式.
目的 分析3種外科手術方式治療繼髮性甲狀徬腺功能亢進的短期及長期療效.方法 迴顧性分析自2004年10月至2014年10月于上海交通大學醫學院附屬仁濟醫院因繼髮性甲狀徬腺功能亢進行甲狀徬腺切除的病例共88例.病例分為3組,組Ⅰ行甲狀徬腺次全切除術,組Ⅱ行甲狀徬腺全切+前臂移植術,組Ⅲ行99锝標記的甲氧基異丁基異腈(99Tcm-MIBI)引導下的甲狀徬腺全切+前臂移植術.收集3組病例術前、術後短期(≤6箇月)及術後長期(＞6箇月)的血鈣、血燐、血甲狀徬腺素(PTH)的結果及臨床癥狀改善程度和術後複髮率及併髮癥等資料.結果 3組術後臨床癥狀均較術前有明顯改善.組Ⅰ和組Ⅱ術後短期內血鈣、血PTH及術後短期複髮率差異均無統計學意義.組Ⅲ術後短期內血鈣、血PTH及術後短期複髮率均低于組Ⅰ及組Ⅱ,差異均有統計學意義(P值均＜0.05).3組術後血燐值差異無統計學意義.組Ⅲ手術時間明顯短于組Ⅱ,差異有統計學意義[(77±13) min比(108±17) min,P＜0.05].組Ⅲ切除的甲狀徬腺暘性率高于組Ⅱ,差異有統計學意義(98.5％比88.7％,P＜0.05).經過長期隨訪,組Ⅰ與組Ⅱ的術後血鈣、血燐、血PTH及術後複髮率差異均無統計學意義.組Ⅲ的術後複髮率均低于組Ⅰ及組Ⅱ的術後複髮率,差異均有統計學意義(3.6％比31.6％、21.4％,P值均＜0.05).結論 治療繼髮性甲狀徬腺功能亢進,甲狀徬腺全切+前臂移植有著較好的療效,而99Tcm-MIBI引導下的甲狀徬腺全切+前臂移植術則可更好的髮現異位及額外的甲狀徬腺,提高手術成功率,同時術中可無需等待冰凍病理,縮短手術時間.在術後隨訪中,複髮率也較低,是一種安全及有效的治療方式.
목적 분석3충외과수술방식치료계발성갑상방선공능항진적단기급장기료효.방법 회고성분석자2004년10월지2014년10월우상해교통대학의학원부속인제의원인계발성갑상방선공능항진행갑상방선절제적병례공88례.병례분위3조,조Ⅰ행갑상방선차전절제술,조Ⅱ행갑상방선전절+전비이식술,조Ⅲ행99득표기적갑양기이정기이정(99Tcm-MIBI)인도하적갑상방선전절+전비이식술.수집3조병례술전、술후단기(≤6개월)급술후장기(＞6개월)적혈개、혈린、혈갑상방선소(PTH)적결과급림상증상개선정도화술후복발솔급병발증등자료.결과 3조술후림상증상균교술전유명현개선.조Ⅰ화조Ⅱ술후단기내혈개、혈PTH급술후단기복발솔차이균무통계학의의.조Ⅲ술후단기내혈개、혈PTH급술후단기복발솔균저우조Ⅰ급조Ⅱ,차이균유통계학의의(P치균＜0.05).3조술후혈린치차이무통계학의의.조Ⅲ수술시간명현단우조Ⅱ,차이유통계학의의[(77±13) min비(108±17) min,P＜0.05].조Ⅲ절제적갑상방선양성솔고우조Ⅱ,차이유통계학의의(98.5％비88.7％,P＜0.05).경과장기수방,조Ⅰ여조Ⅱ적술후혈개、혈린、혈PTH급술후복발솔차이균무통계학의의.조Ⅲ적술후복발솔균저우조Ⅰ급조Ⅱ적술후복발솔,차이균유통계학의의(3.6％비31.6％、21.4％,P치균＜0.05).결론 치료계발성갑상방선공능항진,갑상방선전절+전비이식유착교호적료효,이99Tcm-MIBI인도하적갑상방선전절+전비이식술칙가경호적발현이위급액외적갑상방선,제고수술성공솔,동시술중가무수등대빙동병리,축단수술시간.재술후수방중,복발솔야교저,시일충안전급유효적치료방식.
Objective To analyze the short-term and long-term outcomes of the three operation methods in treatment of secondary hyperparathyroidism.Methods Clinical data of 88 patients who underwent parathyroidectomy for secondary hyperparathyroidism from October 2004 to October 2014 were reviewed retrospectively.Patients were divided into three subgroups,including subtotal parathyroidectomy (group Ⅰ),total parathyroidectomy with autotransplantation (group Ⅱ) and intraoperative 99Tcm-MIBI radioguided total parathyroidectomy with autotransplantation (group Ⅲ).Their serum calcium,phosphorus,serum iPTH results in the pre-operation,short-term (≤ 6 months) and long term (＞ 6 months) of postoperation were collected and compared.The improvements of clinical symptoms together with the postoperative recurrence rate and the complication data were observed and analyzed.Results The symptoms of all patients were improved after the operation.The short-term postoperative serum calcium,serum iPTH and recurrence rate of Group Ⅰ and group Ⅱ were all not statistically significant.The short-term postoperative serum calcium,iPTH and recurrence rate of group Ⅲ were significantly lower than those of group Ⅰ and group Ⅱ (P ＜ 0.05).Postoperative serum phosphorus values of the three groups had no statistical difference.The operation time of group Ⅲ was significantly shorter than that of group Ⅱ ((77 ± 13)vs (108 ± 17) min,P ＜ 0.05).The positive rates were more accurate in group Ⅲ than in group Ⅱ (98.5％ vs 88.7％,P ＜ 0.05).For the long term follow-up,the postoperative serum calcium,phosphorus,serum iPTH and recurrence rate of group Ⅰ and group Ⅱ were not statistically different.The postoperative recurrence rate of group Ⅲwas lower than that of group Ⅰ and group Ⅱ (3.6％ vs 31.6％ and 21.4％ respectively,P ＜ 0.05).Conclusions Total parathyroidectomy with autotransplantation has a good efficacy to treat secondary hyperparathyroidism.The intraoperative 99Tcm-MIBI radioguided total parathyroidectomy with autotransplantation can find the ectopic and supernumerary glands to improve the success rate of operation.And it also can permit omission of frozen section to reduce the operative time.In the postoperative follow-up,the recurrence rate is low,so it is a safe and effective treatment.
