目的:探讨甲状旁腺全切加自体移植(PTX+AT)术后移植物成活率,及其对继发性甲状旁腺功能亢进(SHPT)患者预后和生活质量的影响. 方法:选取2011-02-01至2015-11-30在安徽医科大学第二附属医院成功切除甲状旁腺并行前臂移植的160例维持性血液透析(MHD)患者进行随访.术后2周同时测定双侧前臂甲状旁腺激素(PTH)值,判断移植物存活情况.收集患者术后第1、3、6、9、12月检查钙、磷等生化指标,观察临床症状改善及术后并发症和SHPT复发情况. 结果:(1)术后移植物成活率为66.25％.手术成功患者骨痛、瘙痒等症状显著改善.(2)与术前相比,术后血钙、磷、全段甲状旁腺激素(iPTH)、碱性磷酸酶水平显著下降,血红蛋白、总蛋白、白蛋白水平明显上升(P＜0.05).移植物成活组术后3月和12月血钙水平、术后12月iPTH水平明显高于未成活组(P＜0.05)外,其余指标两组间差异无统计学意义.移植物未成活组中因低钙血症再入院人数略高于成活组,而两组严重低钙血症均好发于透析龄长、术前PTH高及骨骼畸形严重的患者.(3)术后1年内,未成活组死亡2例,成活组死亡l例.成活组术后SHPT复发率高于未成活组(10/106 vs 2/54,P＜0.05). 结论:PTX+AT后移植物成活与否均可显著改善患者预后和生存质量.术后严重低钙血症主要与SHPT的严重程度相关.%Objective:This study was conducted to investigate the survival rate of grafts after total parathyroidectomy with auto-transplantation (PTX+AT) and its impacts on prognosis and quality of life in maintenance hemodialysis(MHD) patients with secondary hyperparathyroidism (SHPT).Methodology:160 MHD patients underwent PTX+AT were recruited from Second Affiliated Hospital of Anhui Medical University between February lth,2011 and November 30th,2015.2 weeks after operation,the allograft function was evaluated via comparing serum intact parathyroid hormone (iPTH) levels between implanted and non-implanted arm.Biochemical parameters were detected pre-and 1 month,3 month,6 month,9 month,12 month post-operation.Clinical symptoms and complications were collected.Results:1.The grafts survival rate was 66.25％.Bone pain and pruritus were remarkably improved in both groups after operation.2.Compared with the preoperative parameters,the levels of Ca,P,iPTH and alkaline phosphatase(ALK) dropped significantly in both groups (P＜ 0.05),and the hemoglobin (Hb),albumin (Alb) and total protein (TP) levels increased markedly in both groups (P＜0.05).Serum levels of Ca at 3 month and 12 month post-operation in survival group were significantly higher than that of compared group.Serum iPTH level at 12 month post-operation in survival group was also dramatically higher than non-survival group.There were no significant differences in other indicators between the two groups.Although slightly more patients readmitted due to hypocalcemia in graft non-survival group,severe hypocalcemia was more common in the patients with longer dialysis vintage,higher PTH value and severer bone pain pre-operation in both groups.3.The recurrence rate of survival group was higher (10/106 vs.2/54,P＜0.05).Conclusion:There were no significant differences on prognosis and quality of life among two groups after PTX+AT.The occurrence of hypocalcemia was positively correlated with the severity of SHPT before operation.
展开▼
