首页|维持性血液透析继发性甲状旁腺功能亢进症采用不同手术方法治疗的效果

维持性血液透析继发性甲状旁腺功能亢进症采用不同手术方法治疗的效果

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目的:探讨维持性血液透析继发性甲状旁腺功能亢进症患者单纯采用甲状旁腺全切术及联合自体前臂移植术治疗效果,并分析不同手术方法对患者颈动脉粥样硬化、运动功能的影响.方法:选取辽宁省健康产业集团本钢总医院 2019 年 9 月—2023 年 9 月收治的维持性血液透析继发性甲状旁腺功能亢进症患者 76 例为研究对象,采用随机数字表法将其分为对照组和试验组,各 38 例.对照组行甲状旁腺全切术治疗,试验组行甲状旁腺全切术+自体前臂移植术治疗.观察两组生化指标[甲状旁腺激素(PTH)、磷(P)、钙(Ca)]、颈动脉粥样硬化指标[颈动脉中层厚度(IMT)、收缩期血流峰值流速(PSV)、舒张末期血流峰值流速(EDV)、阻力指数(RI)]、运动功能指标[手握力、6 min步行距离(6MWD)]变化情况,并对比两组并发症发生率.结果:术后 3 个月,试验组PTH、P、Ca水平均高于对照组,差异均有统计学意义(P<0.05).术后 3 个月,试验组IMT、PSV、EDV、RI水平均低于对照组,差异均有统计学意义(P<0.05).术后 3 个月,试验组手握力、6MWD水平均优于对照组,差异均有统计学意义(P<0.05).两组并发症发生率比较,差异无统计学意义(P>0.05).结论:相较于单纯甲状旁腺全切术,甲状旁腺全切联合自体前臂移植术在维持性血液透析继发性甲状旁腺功能亢进症治疗中,更有利于改善生化指标,减轻颈动脉粥样硬化,改善患者运动功能,且联合术式不增加并发症发生率.
The Effect of Different Surgical Methods in the Treatment of Secondary Hyperparathyroidism in Maintenance Hemodialysis
Objective:To investigate the treatment effect of total parathyroidectomy alone and combined with autologous forearm transplantation in maintenance hemodialysis patients with secondary hyperparathyroidism,and to analyze the effects of different surgical methods on carotid atherosclerosis and motor function.Method:A total of 76 cases of secondary hyperparathyroidism in maintenance hemodialysis patients admitted to General Hospital of Benxi Iron Steel of Liaoning Health Industry Group from September 2019 to September 2023 were selected as the research objects,they were divided into the control group and the test group by random number table method,with 38 cases in each group.The control group received total parathyroidectomy,the test group received total parathyroidectomy+autologous forearm transplantation.The biochemical indicators[parathyroid hormone(PTH),phosphorus(P),calcium(Ca)],carotid atherosclerosis indicators[carotid artery middle thickness(IMT),peak systolic velocity(PSV),end-diastolic velocity(EDV),resistance index(RI)],motor function index[grip strength,6 minute walking distance(6MWD)],and the incidence of complications between two groups were compared.Result:After 3 months of surgery,the levels of PTH,P and Ca in the test group were higher than those in the control group,the differences were statistically significant(P<0.05).After 3 months of surgery,the levels of IMT,PSV,EDV and RI in the test group were lower than those in the control group,the differences were statistically significant(P<0.05).After 3 months of surgery,the grip strength and 6MWD level in the test group were better than those in the control group,the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of complications between the test group and the control group(P>0.05).Conclusion:Compared with total parathyroidectomy alone,total parathyroidectomy combined with autologous forearm transplantation in the treatment of secondary hyperparathyroidism in maintenance hemodialysis is more conducive to improving biochemical indicators,reducing carotid atherosclerosis,improving patients'motor function,and the combined operation does not increase the probability of complications.

Maintenance hemodialysisSecondary hyperparathyroidismTotal parathyroidectomyAutologous forearm transplantation

刘林、戴忠庶、孙亚光、史春红、杜佳伟、于柏江

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辽宁省健康产业集团本钢总医院普外二科 辽宁 本溪 117000

辽宁省健康产业集团本钢总医院血液透析科 辽宁 本溪 117000

辽宁省健康产业集团本钢总医院功能科 辽宁 本溪 117000

维持性血液透析 继发性甲状旁腺功能亢进症 甲状旁腺全切术 自体前臂移植术

2024

中国医学创新
中国保健协会

中国医学创新

影响因子:1.706
ISSN:1674-4985
年,卷(期):2024.21(25)