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find Keyword "继发性甲状旁腺功能亢进症" 6 results
  • 全部甲状旁腺切除加胸锁乳突肌内自体移植术治疗继发性甲状旁腺功能亢进症(附 45 例报道)

    目的 探讨全部甲状旁腺切除加胸锁乳突肌内自体移植术治疗继发性甲状旁腺功能亢进症(SHPT)的疗效及技巧。 方法 总结空军总医院普通外科 2008 年 1 月至 2016 年 5 月期间 45 例 SHPT 行全部甲状旁腺切除加胸锁乳突肌内自体移植术患者的临床资料和随访结果,对其手术前后血磷、血钙和全段甲状旁腺素(iPTH)水平以及手术并发症和远期疗效进行分析。 结果 45 例患者手术均顺利完成,平均手术时间 116 min。45 例患者共切除甲状旁腺 173 枚,其中 40 例患者各切除 4 枚甲状旁腺,3 例各切除 3 枚,2 例各切除 2 枚。术后无喉返神经损伤、出血等严重并发症发生。术后病理结果显示 173 枚甲状旁腺良性增生或腺瘤样增生,其中 1 例合并甲状旁腺癌。术后1 周、6 个月及 1 年血磷、血钙及 iPTH 水平均明显低于术前(P<0.05)。在术后 1~2 周,全部患者的骨痛、皮肤瘙痒等症状均明显好转,食欲改善。术后 1 年复发 1 例(2.22%),口服药物治疗后症状控制,未行手术治疗。 结论 全部甲状旁腺切除加胸锁乳突肌内自体移植术治疗 SHPT 在临床上是安全、有效的。

    Release date:2018-03-13 02:31 Export PDF Favorites Scan
  • 围手术期多学科协作诊治流程在继发性甲状旁腺功能亢进症中的临床应用

    目的总结多学科协作诊治(multidisciplinary team,MDT)模式运用于继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)的效果。方法回顾性收集 2017 年 3 月至 2019 年 5 月期间在成都市第三人民医院按照 MDT 流程完成手术的 45 例 SHPT 患者的临床资料。结果本组 45 例患者的手术均顺利,无术中死亡和围手术期死亡患者。手术时间 56~220 min、(125±40)min;术中出血量 2~30 mL、(12±7)mL;住院时间 7~12 d、(9.07±0.86)d;术前准备时间 2~5 d、(3.26±0.72)d;术后拔管时间 2~5 d、(3.20±0.69)d。与术前的 iPTH 水平相比,术后 1 h、术后 1 周和术后 1 个月的 iPTH 水平均降低(P<0.05)。患者术后的血钙和血磷水平均较术前降低(P<0.01),但手术前后的血钾水平比较差异无统计学意义(P=0.55)。术后 32 例患者的骨及关节疼痛症状均不同程度缓解,其中 3 例无法行走患者可以下地自行行走;9 例瘙痒患者的症状也有明显缓解;4 例不宁腿患者中有 3 例明显缓解;40 例乏力患者中有 15 例自述术后 1 周后乏力症状缓解,19 例自诉术后 1~2 个月一定程度缓解。术后 2 例出现重度低钙血症,1 例出现出血,1 例出现声音轻度嘶哑,6 例出现肺部感染,1 例出现脂肪液化,2 例出现 SHPT 复发。术后有 3 例患者于半年后失访;有 19 例患者于当地医院完成随访,随访时间为8 个月~2.5 年,中位数为 14.5 个月,未出现复发;其余患者于成都市第三人民医院随访 6 个月~2.5 年,中位数为 13.5个月,也未出现复发。结论MDT 的诊疗流程是保障围手术期安全的前提,该流程可以让内外科医生各司其职,紧密配合,更好地监测患者内环境,以减少术后并发症,降低手术风险,缩短术前准备时间,提高治疗效果,最大限度地保障患者安全。

    Release date:2020-09-23 05:27 Export PDF Favorites Scan
  • Application of preoperative stereotactic localization in the operation of secondary hyperparathyroidism

    ObjectiveTo explore the selection and application value of preoperative stereotactic localization in the surgical treatment of secondary hyperparathyroidism.MethodsThe preoperative ultrasound, CT, and methoxyisobutylisonitrile (MIBI) scan data of 54 patients with secondary hyperparathyroidism confirmed by pathological examination in the Department of General Surgery of the 900th Hospital of the Joint Logistics Team from September 2016 to January 2020 were retrospectively analyzed, to explore the localization accuracy of the three methods alone or in combination.ResultsIn this study, a total of 207 parathyroids were detected, 1 was misdiagnosed (ectopic thymus),9 were missed, and 216 parathyroids were removed. The preoperative localization accuracy of CT, ultrasound, and MIBI was the highest (95.39%, 207/217), followed by ultrasound and MIBI (93.55%, 203/217) and CT+MIBI (89.40%, 194/217), compared with other single or two methods, the differences were statistically significant (P<0.05). The accuracy of CT combined with ultrasound localization (82.49%, 179/217) was slightly higher than that of MIBI scan alone (78.80%, 171/217), but the difference was not statistically significant (P=0.060). Although the location accuracy of MIBI scan was slightly higher than that of ultrasound localization (77.88%, 169/217), the difference was not statistically significant (P=0.084).ConclusionIn order to maximize the accuracy of preoperative stereotactic localization of secondary hyperparathyroidism, ultrasound, CT, and MIBI should be combined.

    Release date:2021-02-08 07:10 Export PDF Favorites Scan
  • Effect of γ-detector guided total parathyroidectomy and auto transplantation in treatment of secondary hyperparathyroidism

    Objective To explore the application value of intraoperative gamma detector in patients with chronic kidney disease secondary hyperparathyroidism (sHPT) undergoing total parathyroidectomy (tPTX)+auto transplantation (AT). Methods A retrospective analysis of the clinical data of 110 sHPT patients who received tPTX+AT at Northern Jiangsu Province People’s Hospital from July 2014 to June 2019 was performed. Among them, 80 patients underwent tPTX+AT guided by the gamma detector during the operation (observation group), 30 patients underwent tPTX+AT under routine exploration (control group). We compared the operation time, number of parathyroid glands removed, serum intact parathyroid hormone (iPTH) concentration, serum calcium and phosphorus levels, as well as the occurrence of postoperative complications and recurrence rate were compared between the two groups. Results The number of parathyroid glands removed of the control group was lower than that of the observation group [(3.87±0.35) per case vs. (4.01±0.11) per case, P<0.05], but the operation time of the control group was longer [(115±25) min vs. (75±27) min, P<0.05]. Postoperative iPTH, serum calcium and serum phosphorus levels were significantly reduced in all patients. After the operation, the symptoms of pruritus, bone pain, and muscle weakness were relieved or disappeared. There was no death, dysphagia, drinking water choking cough, and superior laryngeal nerve injury occurred. One patient in the observation group and one patient in the control group had hoarseness, and one patient in the control group had cervical incision bleeding; one patient in the observation group and four patients in the control group suffered short-term postoperative recurrence due to incomplete parathyroidectomy. There was no significant difference in the incidence of complications (χ2=2.413, P>0.05), but the short-term postoperative recurrence rate of the observation group was lower than that of the control group (χ2=7.342, P<0.05). Conclusion Gamma detector is helpful for rapid identification of typical hyperplasia and ectopic parathyroid glands during operation, and can improve the accuracy of tPTX , save operation time, and reduce the recurrence.

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  • 纵隔内异位甲状旁腺功能亢进症的诊治体会:附3例报道

    目的分析纵隔内异位甲状旁腺功能亢进症2次手术的原因及防治策略。方法回顾性收集四川大学华西医院(简称“我院”)甲状腺外科2021年11月至2022年3月期间收治的三发性甲状旁腺功能亢进症患者的临床病理资料。结果共收集到3例患者即病例1~3,其中病例1和病例3为女性,病例2为男性,年龄分别为61、48及57岁。3例患者均因肾功能衰竭行维持性血液透析分别达13、10及9年。病例1和2初次均于外院经第1次行甲状旁腺切除+甲状旁腺自体移植术后甲状旁腺激素(parathyroid hormone,PTH)未持续下降而入我院治疗,发现纵隔内异位甲状旁腺,经评估后行机器人或胸腔镜下甲状旁腺瘤切除术,术后PTH显著下降,骨痛症状显著缓解。病例3初次因骨痛就诊于外院(具体不详)给予口服药物对症治疗后PTH仍持续偏高而入我院治疗,发现颈部及纵隔内异位甲状旁腺,经综合评估后行经颈甲状旁腺切除联合胸腔镜纵隔内甲状旁腺肿物切除,术后PTH下降显著,骨痛症状显著缓解。结论对于纵隔内异位甲状旁腺功能亢进症患者,术前联合多途径检查充分评估,选择合适的手术方式,若条件许可行微创治疗,必要时联合术中PTH检测,以减少再次手术风险。

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  • Analysis of factors influencing hungry bone syndrome in patients with secondary hyperparathyroidism after parathyroidectomy

    ObjectiveTo analyze the factors influencing the hungry bone syndrome (HBS) in patients with secondary hyperparathyroidism (SHPT) after parathyroidectomy. MethodsThe clinical data of patients who underwent parathyroidectomy for SHPT in the 900th Hospital of the Joint Logistics Support Force from January 2016 to May 2021 were retrospectively analyzed. The risk factors for HBS were analyzed by binary logistic regression analysis. The cut-off value of risk factors for predicting postoperative HBS was analyzed by using recieve operating characteristic (ROC) curve. ResultsA total of 89 patients were included in this study, including 44 males and 45 females, with (47±11) years old. There were 42 (47.2%) patients with HBS. Compared with the patients without HBS, the patients with HBS was younger and had higher levels of preoperative parathyroid hormone, potassium, and alkaline phosphatase (ALP), the differences were statistically different (P<0.05). The multivariate binary logistic regression analysis showed that the higher preoperative ALP level was a risk factor for the HBS [OR (95%CI) = 1.014 (1.007, 1.020), P<0.001]. The area under the ROC curve (95%CI) of the preoperative ALP level in distinguishing the patients with HBS from without HBS was 0.957 (0.919, 0.996), and the optimal cut-off value of ALP for predicting postoperative HBS was 278.90 U/L. ConclusionsFrom the preliminary results of this study, it can be concluded that bone conversion status can be differentiated according to preoperative ALP level in patients with SHPT. When preoperative ALP level is higher than cut-off value, it is recommended that calcium supplementation should be given as soon as possible and blood calcium level should be closely monitored.

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