Objective: To evaluate the clinical significance of dissection parathyroidectomy for secondary hyperparathyroidism (SHPT) in patients with renal disease on maintenance dialysis. Methods: We retrospectively reviewed 195 patients with SHPT treated in the Department of Otolaryngology & Head and Neck Surgery of Beijing Civil Aviation General Hospital between September 2009 and September 2017, including 92 males and 103 females, aged from 23 to 77 years old. There were 167 patients by operated firstly and 28 patients by operated secondly for persistent or recurrent SHPT after operation. All patients received dissection parathyroidectomy with parathyroid autograft in the sternocleidomastoid. The easement of symptoms, the levels of serum intact parathyroid hormone (iPTH), serum-ionized calcium, phosphorus, and hemoglobin were compared before and after operation. Data were analyzed by SPSS 22.0 software. Results: Confirmed by postoperative pathology, a total of 804 hyperplastic parathyroid glands were removed in 195 patients with SHPT. Among them, 765 parathyroid glands were clearly identified and located with naked eye. The anatomic distribution of the glands showed 577 (75.4%) in the tracheoesophageal groove. The incidence of ectopic parathyroid glands was 24.6% (188/765). Other 39 (4.9%) hyperplastic parathyroid glands from 22(11.3%) patients, which were not identified and located with naked eye during operation, were pathologically detected in the dissected tissue specimens. Among 195 patients, 28(14.4%) showed supernumerary parathyroid glands. No serious complications occurred after operation. Within 6 months after the operation, the bone pain and skin itch symptoms were completely relieved and, also, the symptoms of muscle weakness, restless leg, anemia and poor sleep quality were significantly alleviated. Following-up at 6 months after surgery showed the serum levels of iPTH [(70.31±60.12) pg/ml], calium [(2.13±0.22) mmol/L], and phosphorus [(1.17±0.27) mmol/L] decreased significantly respectively compared with the preoperative serum levels of iPTH [(1 501.02±167.26) pg/ml], calium [(2.40±0.32) mmol/L], and phosphorus[(2.27±0.50)mmol/L], all with statistically significant differences (P<0.01); the levels of hemoglobin [(120.32±10.63) g/L] and hematocrit [(39.20±3.21)%] were higher than the preoperative levels of hemoglobin[(104.11±15.17) g/L] and hematocrit [(31.25±5.12)%], both with statistically significant differences (t valve was 12.22,18,37,respectively, all P<0.05). Conclusions: Dissection parathyroidectomy is a beneficial and safe surgical procedure for patients with medically refractory SHPT.
目的： 探讨维持性透析肾病患者继发性甲状旁腺功能亢进（secondary hyperparathyroidism，SHPT）行清扫式甲状旁腺全切除术（dissection parathyroidectomy，dPTX）的临床价值。 方法： 回顾性分析北京民航总医院耳鼻咽喉头颈外科2009年9月至2017年9月收治的195例维持性透析肾病患者SHPT的临床资料，其中男性92例，女性103例，年龄23~77岁。首次手术167例，外院术后持续性或复发性SHPT再次手术28例。采用dPTX切除全部甲状旁腺，同期行胸锁乳突肌移植。比较手术前后症状缓解程度，血清全段甲状旁腺素、血钙、血磷、血红蛋白和红细胞压积的变化。采用SPSS 22.0统计学软件进行统计学分析。 结果： 经术后病理证实，195例患者共切除增生的甲状旁腺804枚。其中术中肉眼识别且位置明确的甲状旁腺765枚，位于双侧气管食管沟内577枚（75.4%），异位甲状旁腺188枚（24.6%）。术中肉眼未识别出、位置不明确而在清扫组织标本中病理检出的甲状旁腺39枚（4.9%），来自22例患者（11.3%）。额外甲状旁腺患者的发生率为14.4%（28/195）。围手术期未发生严重的并发症。术后半年所有患者骨痛、皮肤瘙痒症状全部缓解，肌无力、不宁腿、贫血及睡眠质量均明显改善。术后半年血清全段甲状旁腺素（70.31±60.12）pg/ml、血钙（2.13±0.22）mmol/L、血磷（1.17±0.27）mmol/L均较术前[分别为（1 501.02±167.26）pg/ml、（2.40±0.32）mmol/L、（2.27±0.50）mmol/L]下降，差异有统计学意义（t值分别为4.982、2.325、7.326, P值均<0.01）。术后半年血红蛋白（120.32±10.63）g/L和红细胞压积（39.20±3.21）%较术前[分别为（104.11±15.17）g/L、（31.25±5.12）%]升高，差异有统计学意义（t值分别为12.22、18.37，P值均<0.05）。 结论： dPTX治疗维持性透析肾病患者的SHPT安全可靠。.
Keywords: End-stage renal disease; Hyperparathyroidism, secondary; Surgery; Total parathyroidectomy.