甲状旁腺全切除+前臂自体移植术对肾功能衰竭继发甲状旁腺功能亢进合并关节周围软组织钙化患者的疗效分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

张智 ¹ , 李建文 ¹ , 陈伟杰 ¹ , 黎思毅 ¹ , 许托 ¹ , 覃文懿 ¹ , 蔡文松 ² ,  徐波 ²

1. ;
2. ;

Corresponding author：

徐波, Email: aabb97@163.com

Keywords：

甲状旁腺全切除+前臂自体移植术; 肾脏功能衰竭继发甲状旁腺功能亢进; 关节周围软组织钙化; 疗效

DOI：

10.7507/1007-9424.201709015

Video：

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目的探讨甲状旁腺全切除+前臂自体移植术（TPT+AG）对肾脏功能衰竭（简称肾衰）继发甲状旁腺功能亢进（简称甲旁亢）患者关节周围软组织钙化的疗效。方法回顾性分析广东医科大学附属医院 2015 年 4 月至 2017 年 4 月期间收治的 11 例肾衰继发甲旁亢合并关节周围软组织钙化患者的临床资料，均采用 TPT+AG 治疗，比较手术前后血清甲状旁腺激素（PTH）、钙、磷水平、钙磷乘积变化情况，并观察术后关节周围软组织钙化改善的情况。结果 11 例患者术后第 6 个月时血磷、钙磷乘积均在正常范围内，有 10 例患者在术后 6 个月于体表均未及原有肿物，临床观察肿物消失最短时间为 2 个月，其原有的活动障碍、局部麻木、疼痛等不适症状完全消失，仅 1 例患者术后肘关节肿物缩小不明显。结论本研究有限病例的初步研究结果提示，对于肾衰继发甲旁亢合并关节周围软组织钙化的患者，TPT+AG 是有效的治疗方法，患者可能仅通过 TPT 就可使关节周围软组织钙化明显缩小或者完全消除。

Citation： 张智, 李建文, 陈伟杰, 黎思毅, 许托, 覃文懿, 蔡文松, 徐波. 甲状旁腺全切除+前臂自体移植术对肾功能衰竭继发甲状旁腺功能亢进合并关节周围软组织钙化患者的疗效分析. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(2): 225-228. doi: 10.7507/1007-9424.201709015 Copy

1.	Tentori F, Blayney MJ, Albert JM, et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis, 2008, 52(3): 519-530.
2.	Moe S, Drüeke T, Cunningham J, et al. Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int, 2006, 69(11): 1945-1953.
3.	Floege J, Kim J, Ireland E, et al. Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population. Nephrol Dial Transplant, 2011, 26(6): 1948-1955.
4.	Raggi P, Boulay A, Chasan-Taber S, et al. Cardiac calcification in adult hemodialysis patients. A link between end-stage renal disease and cardiovascular disease? J Am Coll Cardiol, 2002, 39(4): 695-701.
5.	de Alarcón RM, Palomares M, Marfil A, et al. Posttransplant regression of uremic tumoral calcinosis.Nefrologia, 2007, 27(3): 378-381.
6.	Baek D, Lee SE, Kim WJ, et al. Greater trochanteric pain syndrome due to tumoral calcinosis in a patient with chronic kidney disease. Pain Physician, 2014, 17(6): E775-E782.
7.	Xu Z, Tang C, Zhang L, et al. Multiple ectopic calcification in subcutaneous tissues detected by bone scintigraphy in a patient with chronic renal failure. Clin Nucl Med, 2015, 40(6): 512-514.
8.	周建平, 李晓莉, 董明, 等. 我国原发性甲状腺功能亢进症的误诊情况分析. 中国现代医学杂志, 2006, 16(7): 1040-1042.
9.	Yang H, Curinga G, Giachelli CM. Elevated extracellular calcium levels induce smooth muscle cell matrix mineralization in vitro. Kidney Int, 2004, 66(6): 2293-2299.
10.	Kapustin AN, Davies JD, Reynolds JL, et al. Calcium regulates key components of vascular smooth muscle cell-derived matrix vesicles to enhance mineralization. Circ Res, 2011, 109(1): e1-e12.
11.	Sunder S, Verma H, Venkataramanan K. Cervical tumoral calcinosis with secondary hyperparathyroidism in a chronic hemodialysis patient. Hemodial Int, 2013, 17(3): 458-462.
12.	曲建坤, 王兆新, 王焱. 甲状旁腺切除对继发性甲状旁腺功能亢进的维持性血透患者左心功能及生存质量的影响. 临床心血管病杂志, 2015, 31(10): 1078-1081.
13.	Latif F, Khalid MM, Khan F, et al. Role of hyperphosphatemia-mediated vascular calcification in cardiovascular outcomes and its management: a review. J Cardiovasc Med (Hagerstown), 2013, 14(6): 410-415.
14.	Binnani P, Aggarwal V, Bahadur MM, et al. Tumoral calcinosis (Teutschlander disease) in a dialysis patient. Indian J Nephrol, 2008, 18(3): 122-124.
15.	廖常志, 张静, 何强. 等. 慢性肾脏病患者血清 iPTH 及钙磷异常的发生率. 四川医学, 2011, 32(9): 1338-1340.
16.	Niemann KE, Kröpil F, Hoffmann MF, et al. A 23-year-old patient with secondary tumoral calcinosis: Regression after subtotal parathyroidectomy: A case report. Int J Surg Case Rep, 2016, 23: 56-60.

1. Tentori F, Blayney MJ, Albert JM, et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis, 2008, 52(3): 519-530.
2. Moe S, Drüeke T, Cunningham J, et al. Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int, 2006, 69(11): 1945-1953.
3. Floege J, Kim J, Ireland E, et al. Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population. Nephrol Dial Transplant, 2011, 26(6): 1948-1955.
4. Raggi P, Boulay A, Chasan-Taber S, et al. Cardiac calcification in adult hemodialysis patients. A link between end-stage renal disease and cardiovascular disease? J Am Coll Cardiol, 2002, 39(4): 695-701.
5. de Alarcón RM, Palomares M, Marfil A, et al. Posttransplant regression of uremic tumoral calcinosis.Nefrologia, 2007, 27(3): 378-381.
6. Baek D, Lee SE, Kim WJ, et al. Greater trochanteric pain syndrome due to tumoral calcinosis in a patient with chronic kidney disease. Pain Physician, 2014, 17(6): E775-E782.
7. Xu Z, Tang C, Zhang L, et al. Multiple ectopic calcification in subcutaneous tissues detected by bone scintigraphy in a patient with chronic renal failure. Clin Nucl Med, 2015, 40(6): 512-514.
8. 周建平, 李晓莉, 董明, 等. 我国原发性甲状腺功能亢进症的误诊情况分析. 中国现代医学杂志, 2006, 16(7): 1040-1042.
9. Yang H, Curinga G, Giachelli CM. Elevated extracellular calcium levels induce smooth muscle cell matrix mineralization in vitro. Kidney Int, 2004, 66(6): 2293-2299.
10. Kapustin AN, Davies JD, Reynolds JL, et al. Calcium regulates key components of vascular smooth muscle cell-derived matrix vesicles to enhance mineralization. Circ Res, 2011, 109(1): e1-e12.
11. Sunder S, Verma H, Venkataramanan K. Cervical tumoral calcinosis with secondary hyperparathyroidism in a chronic hemodialysis patient. Hemodial Int, 2013, 17(3): 458-462.
12. 曲建坤, 王兆新, 王焱. 甲状旁腺切除对继发性甲状旁腺功能亢进的维持性血透患者左心功能及生存质量的影响. 临床心血管病杂志, 2015, 31(10): 1078-1081.
13. Latif F, Khalid MM, Khan F, et al. Role of hyperphosphatemia-mediated vascular calcification in cardiovascular outcomes and its management: a review. J Cardiovasc Med (Hagerstown), 2013, 14(6): 410-415.
14. Binnani P, Aggarwal V, Bahadur MM, et al. Tumoral calcinosis (Teutschlander disease) in a dialysis patient. Indian J Nephrol, 2008, 18(3): 122-124.
15. 廖常志, 张静, 何强. 等. 慢性肾脏病患者血清 iPTH 及钙磷异常的发生率. 四川医学, 2011, 32(9): 1338-1340.
16. Niemann KE, Kröpil F, Hoffmann MF, et al. A 23-year-old patient with secondary tumoral calcinosis: Regression after subtotal parathyroidectomy: A case report. Int J Surg Case Rep, 2016, 23: 56-60.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

甲状旁腺全切除+前臂自体移植术对肾功能衰竭继发甲状旁腺功能亢进合并关节周围软组织钙化患者的疗效分析

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