| 摘要: |
| 目的 探究微波消融序贯甲状旁腺腺瘤切除术在原发性甲状旁腺功能亢进症伴高钙危象患者中的治疗效果。
方法 纳入内科治疗无效且有急诊手术禁忌证的原发性甲状旁腺功能亢进症伴高钙危象患者11例。患者在诊断高钙危象后内科治疗48小时内无效，急诊行甲状旁腺微波消融治疗，临床症状消失、血钙降至正常范围后再行甲状旁腺腺瘤切除术。对甲状旁腺腺瘤微波消融后甲状旁腺激素、血钙磷水平的变化数据进行分析，总结实验室检查结果降至正常后的最佳手术时机，研究微波消融及序贯手术对患者临床症状及血钙磷等实验室检查结果的影响。
结果 患者甲状旁微波消融术后6h血清甲状旁腺激素显著下降，微波消融治疗前血钙水平为（3.49±0.16 mmol/L），微波消融治疗后血钙降至（2.39±0.63 mmol/L），在消融术后2天内降至安全范围趋于平稳。术后第1天血清甲状旁腺激素、钙较术前降低，磷比术前明显升高（P＜0.01），5例（45.5%）患者在术后第2天内可发生低钙血症，补充口服钙及静脉钙后2天恢复正常；心率较术前明显下降、精神状况明显好转、关节疼痛、骨痛及恶心呕吐等胃肠道症状在术后1周内明显改善。
结论 微波消融序贯甲状旁腺腺瘤切除术是治疗原发性甲状旁腺功能亢进症伴高钙危象的一种新型安全有效的方法。在原发性甲状旁腺功能亢进症伴高钙危象有急诊手术禁忌证患者的临床治疗中，首先采用微波消融灭活甲状旁腺腺瘤，可显著降低血钙和甲状旁腺激素水平，为限期手术创造条件，序贯手术治疗可显著稳定改善症状和降低甲状旁腺激素水平。 |
| 关键词: 甲状旁腺 原发性甲状旁腺功能亢进症 高钙危象 微波消融 |
| DOI： |
| 投稿时间：2024-05-19修订日期：2024-09-03 |
| 基金项目:湖北省卫生计生委联合基金立项项目(WJ2018H0014) |
|
| Efficacy analysis of microwave ablation and sequential surgery in the treatment of primary hyperparathyroidism with hypercalcium crisis |
| Yuan Qianqian,Hou Jinxuan,Zhou Rui,Wu Gaosong. |
| () |
| Abstract: |
| Objective To explore the therapeutic effect of microwave ablation plus parathyroidectomy in primary hyperparathyroidism (PHPT) with hypercalcium crisis.
Methods Eleven patients with primary hyperparathyroidism with hypercalcemia who did not respond to medical treatment and had contraindications to emergency surgery were enrolled. After the diagnosis of hypercalcemia crisis, the patients were ineffective in medical treatment within 48 hours, and emergency microwave ablation of the parathyroid adenoma was performed, and the parathyroid adenoma was resected after the clinical symptoms disappeared and the serum calcium dropped to the normal range. The changes of parathyroid hormone and serum calcium and phosphorus levels after microwave ablation of parathyroid adenoma were analyzed, and the optimal timing of surgery after the laboratory test results were reduced to normal, and the effects of microwave ablation and sequential surgery on the clinical symptoms, calcium and phosphorus laboratory results were investigated.
Results Six hours after thermal ablation of the parathyroid gland, the serum parathyroid hormone levels of the patients decreased significantly. The pre-ablation serum calcium level was (3.49±0.16 mmol/L), which decreased to (2.39±0.63 mmol/L) after thermal ablation. The serum calcium level decreased to the safe range and stabilized within two days. One day after surgery, the serum parathyroid hormone and calcium levels decreased, and the phosphorus level increased significantly compared with before surgery (P<0.01). Low calcium levels occurred in 5 patients (45.5%) within 2 days after surgery, but were restored to normal after calcium supplementation via oral and intravenous administration. Heart rate decreased significantly, and the mental and joint symptoms, bone pain, and gastrointestinal symptoms such as nausea and vomiting improved significantly within one week after surgery.
Conclusion Microwave ablation sequential to surgery is a novel, safe and effective method in treating primary hyperparathyroidism with hypercalcemia. In the clinical treatment of patients with primary hyperparathyroidism with hypercalcemia and contraindications to emergency surgery, microwave ablation is first used to inactivate parathyroid adenoma, which can significantly reduce the level of calcium and parathyroid hormone, and create conditions for surgery. Sequential surgery is significant in improving symptoms and reducing parathyroid hormone levels. |
| Key words: Parathyroid Primary hyperparathyroidism Hypercalcium crisis Microwave ablation |
