CAJ | 학술논문

目的探讨不同自体移植方法在甲状旁腺全切除及自体移植术治疗继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)中的效果.方法回顾性分析2012年1月至2013年12月间90例在安徽医科大学第二附属医院普外科接受甲状旁腺全切除及自体移植术的慢性肾衰SHPT患者的临床资料,其中前臂肌肉移植组39例,前臂真皮下移植组51例,前臂肌肉移植组1例和前臂真皮下移植组2例因术后当天全段甲状旁腺激素(iPTH) ＞400 pg/ml排除研究之外.比较2组移植时间,术后2周、1个月、3个月及6个月血浆iPTH水平,探讨2种方法疗效.结果前臂真皮下移植组移植时间明显短于肌肉移植组,差异有统计学意义(11.46(2.63) min vs 22.12(3.78) min;t=0.632,P＜0.05).前臂真皮下移植组术后2周血PTH明显低于前臂肌肉移植组(P＜0.05),而2组术后1、3及6个月血iPTH水平差异无统计学意义(P＞0.05).前臂肌肉移植组移植甲状旁腺致SHPT 1例,前臂肌肉移植组和前臂真皮下移植组均有1例原位甲状旁腺增生致SHPT.结论尿毒症SHPT甲状旁腺前臂皮下移植方法较肌肉移植具有手术简便、种植时间短、术后复发时易于再次切除的优点.
목적 탐토불동자체이식방법재갑상방선전절제급자체이식술치료계발성갑상방선공능항진(secondary hyperparathyroidism,SHPT)중적효과.방법 회고성분석2012년1월지2013년12월간90례재안휘의과대학제이부속의원보외과접수갑상방선전절제급자체이식술적만성신쇠SHPT환자적림상자료,기중전비기육이식조39례,전비진피하이식조51례,전비기육이식조1례화전비진피하이식조2례인술후당천전단갑상방선격소(iPTH) ＞400 pg/ml배제연구지외.비교2조이식시간,술후2주、1개월、3개월급6개월혈장iPTH수평,탐토2충방법료효.결과 전비진피하이식조이식시간명현단우기육이식조,차이유통계학의의(11.46(2.63) min vs 22.12(3.78) min;t=0.632,P＜0.05).전비진피하이식조술후2주혈PTH명현저우전비기육이식조(P＜0.05),이2조술후1、3급6개월혈iPTH수평차이무통계학의의(P＞0.05).전비기육이식조이식갑상방선치SHPT 1례,전비기육이식조화전비진피하이식조균유1례원위갑상방선증생치SHPT.결론 뇨독증SHPT갑상방선전비피하이식방법교기육이식구유수술간편、충식시간단、술후복발시역우재차절제적우점.
Objective To compare the effects of intramuscular or subcutaneous forearm parathyroid autotransplantation after total parathyroidectomy on patients with renal hyperparathyroidism.Methods From Jan.2012 to Dec.2013,total parathyroidectomy was carried out in 90 patients with renal hyperparathyroidism.According to the location of their parathyroid autograft,patients were divided into intramuscular group (n =39)and subcutaneous group(n =51).One patient in the intramuscular group and two in the subcutaneous group were excluded for the high levels of intact parathyroid hormone (iPTH) the day after operation.iPHT was analyzed 2 weeks,1 month,3 and 6 months after surgery.Results The time of autotransplantation was significantly shorter in subcutaneous group than in intramuscular group (11.46 (2.63) min vs 22.12 (3.78) min;t =0.632,P ＜ 0.05).iPTH levels were significantly lower in subcutaneous group than in intramuscular group 2 weeks after operation (P ＜ 0.05).There was no significant difference between the 2 groups regarding iPTH levels at 1 month,3 or 6 months after surgery.In the follow-up one patient in intramuscular group and one in subcutaneous group had graft-dependent hyperparathyroidism.Conclusion As compared to intramuscular parathyroid autotransplantation,subcutaneous parathyroid autotransplantation has advantages of simpler to operate,shorter autoimplantation time and easier to autograftectomy.