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find Keyword "继发性甲状旁腺功能亢进" 15 results
  • Efficacy of Subtotal Parathyroidectomy and Total Parathyroidectomy Plus Parathyroid Autotransplantation in Treatment of Secondary Hyperparathyroidism

    ObjectiveTo compare the efficacy of subtotal parathyroidectomy(sPTX) and total parathyroidectomy (tPTX) plus parathyroid autotransplantation(AT) in treatment of secondary hyperparathyroidism(SHPT). MethodsClinical data of 76 cases of uremia SHPT who underwent sPTX(n=19) and tPTX+AT(n=57) in Xinjiang Armed Police Corps Command Military Hospital and The Xinjiang Uygur Autonomous Region People's Hospital were retrospectively analyzed(from Feb. 2005 to Sep. 2012). ResultsOf the 76 cases, 68 cases(89.5%) got successful surgery and 8 cases (10.5%) suffered non-complete resection, all cases had relief on bone pain, and 14 cases had relief on pruritus(26.9%, 14/52). The values of serum calcium on 1 day, 7 days, and 6 months after operation were lower in tPTX+AT group (P<0.05), and value of iPTH in 6 months after operation was lower too(P<0.05). The operation time, blood loss, hospital stay, and hospital cost in tPTX+AT group were all higher or longer(P<0.05). All of the 76 cases were followed up for 6-18 months(the median time was 8.7 months). During the followed-up, 2 cases died and 2 cases recurred in tPTX+AT group, 1 case died and 7 cases recurred in sPTX group, that the recurrence rate was higher in sPTX group (P<0.05). ConclusiontPTX+AT has lower recurrence rate, but with longer operation time and hospital stay, more blood loss, and expensive cost, so the choice of surgery for SHPT should be based on the comprehensive situation.

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  • 甲状旁腺全切除术治疗继发性甲状旁腺功能亢进12例分析

    目的总结应用甲状旁腺全切除且不移植手术治疗继发性甲状旁腺功能亢进(SHPT)在围手术期的处理经验。 方法对我院2012年12月至2015年1月期间12例SHPT患者行甲状旁腺全切除且不移植手术的疗效进行回顾性分析,比较术前、术后血甲状旁腺激素(PTH)、血钙、血磷、血清碱性磷酸酶(AKP)值及临床症状改善情况。 结果12例患者术后骨痛、皮肤瘙痒症状明显缓解,血PTH值术后迅速下降,6个月后恢复至正常范围,血钙均迅速下降并低于正常,AKP指标下降缓慢,血磷指标恢复正常。随访1~2年未出现复发。1例患者于术后4个月死于脑血管意外。 结论甲状旁腺全切除且不移植治疗SHPT安全、有效,低钙血症是术后防治重点,多学科协作治疗有利于患者平稳渡过围手术期。

    Release date:2021-06-24 01:08 Export PDF Favorites Scan
  • Effects of Lanthanum Carbonate on Serum Calcium and Phosphorus of CAPD Patients with Chronic Renal Failure Receiving Calcitriol Pulse Therapy Due to Secondary Hyperparathyroidism

    ObjectiveTo explore and discuss the effects of lanthanum carbonate on serum calcium and phosphorus of continuous ambulatory peritoneal dialysis (CAPD) patients with chronic renal failure receiving calcitriol pulse therapy due to secondary hyperparathyroidism (SHPT). MethodsCAPD patients caused by SHPT in peritoneal dialysis centre of the Qingdao Municipal Hospital of Eastern Hospital from March to June, 2013 were selected and randomly divided into two groups (lanthanum carbonate group and calcium carbonate group). The lanthanum carbonate group were treated with oral lanthanum carbonate and calcitriol pulse therapy, while the calcium carbonate group were treated with calcium carbonate and calcitriol. Change of levels of serum calcium, phosphorus and iPTH were observed and statistic analysis was conducted using SPSS 17.0. ResultsA total of 40 CAPD patients were included, 20 cases in each group. After 12-week treatment, levels of serium phosphate (t=5.095, P=0.000) and iPTH (t=1.225, P=0.000) in the lanthanum carbonate group were significantly lower than those before treatment. The levels of serum calcium (t=1.127, P=0.001) and phosphate (t=2.035, P=0.000) in the lanthanum carbonate group were significantly lower than those in the calcium carbonate group (P < 0.05). ConclusionLanthanum carbonate serves as a useful approach to improve hypercalcemia and the hyperphosphatemia in CAPD patients receiving calcitriol pulse therapy due to SHPT.

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  • 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
  • Therapeutic efficacy evaluation of parathyroidectomy for 50 patients with uremic secondary hyperparathyroidism

    ObjectiveTo explore therapeutic efficacy of parathyroidectomy (PTX) in treatment of secondary hyperparathyroidism (SHPT) in patients with end-stage renal disease.MethodsThe clinical data of 50 patients who underwent PTX for uremic SHPT from January 2016 to March 2018 were collected retrospectively. The changes of serum calcium, phosphorus, and intact parathyroid hormone (iPTH) before the surgery and 1 d, 7 d, 1 month, 3 months and 12 months after the surgery were analyzed. In addition, the improvement of clinical symptoms together with the postoperative recurrence and complications were observed.ResultsTen patients underwent the subtotal PTX (SPTX), 5 cases underwent the total PTX (TPTX), and 35 cases underwent the TPTX with autotransplantation (TPTX+AT). The PTXs were performed successfully in 47/50 (94.0%) patients. After the PTX, the bone pain and skin itching were alleviated, 3 cases had the temporary injury of recurrent laryngeal nerve and the hypoparathyroidism was found in 1 case. The levels of postoperative serum iPTH, calcemia, and phosphorus were lower than those at the preoperative level, the differences were statistically significant (P<0.050). The postoperative hypocalcemia was frequently seen in 38/50 (76.0%) patients, and it was effectively controlled by the intravenous calcium. After the follow-up for 3 months, the SHPT recurred in 5 cases (10.0%), of whom 3 cases underwent the TPTX+AT. The relapse rate in 12 months after the operation was 9.1% (2/22). There were no statistical differences among the three PTXs methods in the operation successful rate (χ2=3.351, P=0.211) and relapse rates in 3 months (χ2=1.321, P=0.753) and 12 months (χ2=1.794, P=0.411) after the operation.ConclusionsIn China, TPTX+AT is more common than SPTX and TPTX in clinical application. Operations of SPTX, TPTX, and TPTX+AT are safe and effective therapeutic methods for uremic SHPT, which can significantly improve biochemical indicators and quality of life of patients.

    Release date:2019-01-16 10:05 Export PDF Favorites Scan
  • 超声辅加绘图技术在继发性甲状旁腺功能亢进手术前定位中的应用价值

    目的探讨超声辅加绘图技术对继发性甲状旁腺功能亢进甲状旁腺术前定位的效果。方法前瞻性收集 2017 年 6 月至 2018 年 6 月期间在吉林大学中日联谊医院甲状腺外科行手术治疗的继发性甲状旁腺功能亢进患者 20 例,术前由术者亲自操作超声检查。前 5 例(超声组)仅行超声检查,后 15 例(超声辅加绘图组)采取超声辅加手绘标记技术,记录术前定位与术中甲状旁腺位置的符合率。结果超声组的超声识别率为 77.78%(14/18),病理诊断符合率为 100%(18/18);超声辅加绘图组的超声识别率为 93.85%(61/65),病理诊断符合率为 100%(65/65)。2 组的超声识别率比较差异有统计学意义(χ2=0.850,P<0.05),超声辅加绘图组的超声识别率较高。超声组患者的手术时间长于超声辅加绘图组(t=0.876,P=0.041)。2 组患者术后均未出现喉返神经损伤,术后复查喉镜均未出现声带麻痹。结论对继发性甲状旁腺功能亢进患者,术前超声辅加绘图技术定位甲状旁腺快速而准确,在临床制定手术方案、术中精准切除甲状旁腺及缩短手术时间方面有一定的应用价值。

    Release date:2019-06-05 04:24 Export PDF Favorites Scan
  • Internal medicine department management during surgical treatment of secondary hyperparathyroidism based on multiple disciplinary team

    ObjectiveTo investigate the role of multiple disciplinary team (MDT) during surgical treatment of renal secondary hyperparathyroidism (SHPT), and identify management points of Departments of Nephrology and Endocrinology.MethodsThe data of patients with chronic kidney disease undergoing surgical treatment for SHPT in West China Hospital of Sichuan University between January 2009 and December 2018 were retrospectively collected. We explained the surgical treatment of MDT in the management of renal SHPT, and compared the changes before and after the establishment of MDT.ResultsA total of 187 patients including 101 males and 86 females were enrolled, with an average age of (47.60±11.28) years old and median dialysis vintage of 7 years. Under MDT, the number of patients with parathyroidectomy increased [(8.50±5.10) vs. (59.50±2.12) patients/year, P<0.001] and the completion rate of preoperative examinations were greatly improved (P<0.001). The success rate of surgery was also increased (86.8% vs. 97.5%, P=0.010). Proportion of patients who were admitted to the Department of Nephrology was significantly increased (39.7% vs. 84.9%, P<0.001). Most patients after surgery were transferred to the Department of Endocrinology (5.9% vs. 77.3%, P<0.001) to manage postoperative complications and metabolic bone disease, and thus normalized the management of SHPT.ConclusionsThe MDT contributes to management of renal SHPT, which is worthy of popularization and spreading. The management of internal medicine departments during surgical treatment of SHPT based on MDT is important, because they can be helpful to complete preoperative examinations and preoperative preparation as well as to alleviate postoperative complications.

    Release date:2019-08-15 01:18 Export PDF Favorites Scan
  • Actualities in surgical treatment of uremic secondary hyperparathyroidism

    ObjectiveTo summarize the current treatment status of uremic secondary hyperparathyroidism (SHPT) in order to improve the understanding of uremic SHPT and to guide clinical work.MethodThe relevant literatures at home and abroad on surgical treatment of uremic SHPT were readed and reviewed.ResultsFor intractable SHPT patients with ineffective medical treatment, surgical treatment was still irreplaceable, which could significantly improve biochemical indicators and quality of life of SHPT patients. However, there was no unified standard for surgical indications and the choice of different operation methods. In addition, there was a certain controversy about whether there was a need for preoperative parathyroidectomy in patients with SHPT who were willing to have a kidney transplant.ConclusionAlthough there are still some problems need to be solved in surgical treatment of SHPT, however, it’s widely recognized and used by clinicians, which can improve the symptoms of SHPT patients and bring bettersurvival benefits.

    Release date:2020-08-19 12:21 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
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