继发性甲状旁腺功能亢进手术治疗的现状及进展

Current situation and progress of surgical treatment for secondary parathyroidism

摘要:

慢性肾脏病（chronic kidney disease，CKD）患者由于长期维生素D缺乏、低钙血症和高磷血症刺激，常发生继发性甲状旁腺功能亢进（secondary hyperparathyroidism，SHPT），几乎所有CKD患者在开始透析后逐渐出现这种情况。SHPT是慢性肾衰竭患者最主要的死亡原因。目前药物治疗会随着病情发展，逐渐出现耐受，导致患者最终仍需要手术治疗。SHPT手术适用于内科药物无法控制的难治性SHPT，且影像检查发现甲状旁腺明显增大。SHPT的手术方式包括甲状旁腺次全切除术、甲状旁腺全切除+自体移植、甲状旁腺全切除术，但何种术式是治疗SHPT的最佳选择尚有争议。SHPT复发是最常见的术后并发症，目前可采用吲哚菁绿术中成像及术中甲状旁腺激素监测提高手术的成功率。总之，SHPT发病率高且预后差，在外科治疗方面还有许多问题有待进一步研究。

Abstract:

Secondary hyperparathyroidism (SHPT) often occurs in patients with chronic renal disease (CKD) due to long-term vitamin D deficiency, hypocalcemia and hyperphosphatemia. Almost all CKD patients gradually develop this situation after dialysis. SHPT is the leading cause of death in patients with chronic renal failure. However, drug therapy is gradually tolerated with the development of the disease, leading to the need for surgical treatment. Surgery for SHPT is suitable for patients with refractory SHPT that cannot be controlled by medical drugs and whose parathyroid glands are significantly enlarged on imaging examination. The surgical methods include subtotal parathyroidectomy, total parathyroidectomy with autotransplantation, and total parathyroidectomy. However, the best choice for SHPT remains controversial. Recurrence of SHPT is the most common postoperative complication, Intraoperative imaging of indocyanine green and intraoperative para-thyroid hormone assay can be used to improve the surgery. In a word, SHPT has a high incidence and poor prognosis. There are still many problems in surgical treatment that need further study.