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目的对比尿毒症后继发性甲状旁腺功能亢进症(SHPT)进行甲状旁腺次全切除术(sPTX)和甲状旁腺全切除(tPTX)的效果,为提高患者预后提供理伦依据。方法收集2015年6月到2016年12月深圳市人民医院接诊的110例尿毒症后SHPT患者,随机分为两组。tPTX组(54例)行tPTX,sPTX组(56例)行sPTX,对比两种手术的效果。结果 110例患者手术成功98例,切除不足12例。患者术后关节疼痛均都减轻102例,皮肤瘙痒情况减退60例。tPTX组术后1、7 d及6个月的血钙程度较sPTX组降低(P<0.05),术后6个月的tPTH水平低于sPTX组(P<0.05)。随访6~18个月两组的复发率,tPTX组3.70%(2/54),sPTX组为23.21%(13/56),差异有统计学意义(P<0.05)。两组患者均未出现明显的不良反应。结论尿毒症后tPTX术后低钙血症发生率较高,经补钙等对症处理可以缓解;但tPTX的术后复发率低于sPTX。
Objective To compare the effect of subtotal parathyroidectomy (sPTX) and total parathyroidectomy (tPTX) after uremic secondary hyperparathyroidism (SHPT), and to provide a reason for increasing the prognosis of patients. Methods A total of 110 post-uremic SHPT patients admitted to Shenzhen People’s Hospital from June 2015 to December 2016 were randomly divided into two groups. The tPTX group (n = 54) underwent tPTX and the sPTX group (n = 56) performed sPTX, comparing the effects of the two procedures. Results In the 110 cases, 98 cases were successfully operated and 12 cases were resected. Patients with postoperative joint pain were relieved 102 cases, skin pruritus 60 cases. The levels of serum calcium in the tPTX group at 1, 7 and 6 months after operation were lower than those in the sPTX group (P <0.05). The tPTH level at 6 months after operation was lower than that of the sPTX group (P <0.05). The follow-up of 6-18 months showed that the recurrence rate was 3.70% (2/54) in tPTX group and 23.21% (13/56) in sPTX group, the difference was statistically significant (P <0.05). No significant adverse reactions occurred in both groups. Conclusions The incidence of hypocalcemia after tPTX is higher after uremia and can be relieved by symptomatic treatment such as calcium supplement. However, the recurrence rate of tPTX is lower than that of sPTX.