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目的:探讨超声引导下经皮穿刺微波热消融治疗维持性血液透析(MHD)继发性甲状旁腺功能亢进腺瘤增生的临床短期疗效及安全性。方法:对10例MHD严重继发性甲状旁腺功能亢进(SHPT)共32枚腺体在局部麻醉下经超声引导行微波热消融治疗,观察消融前后血清全段甲状旁腺(i PTH)、钙及磷水平,并评价瘙痒、骨痛等伴随症状的缓解情况以及消融相关的副作用。结果:10例患者术后即刻、1 d、1周、2周、1个月、3个月的血清i PTH及钙磷指标均有明显下降,差异有统计学意义(P<0.05);术后i PTH下降率>30%共10例,占100%;2例术前血清i PTH达4 000 pg/ml以上,术后仍处于较高水平,但骨痛、瘙痒等症状明显缓解;2例术后3个月血清i PTH上升至600 pg/ml以上,经活性维生素D等药物治疗后下降至300 pg/ml以下。2例(20%)术后出现声音嘶哑,均于1个月内缓解;所有病例均无气管、食管、血管及颈部肌肉损伤,未发生感染。结论:经超声引导微波热消融治疗MHD患者严重继发性甲状旁腺功能亢进,短期疗效确切、安全、创伤小、并发症少,是一种值得推广的临床治疗新方法。
Objective: To investigate the short-term clinical efficacy and safety of ultrasound guided percutaneous microwave ablation in the treatment of secondary hemodialysis (MHD) hyperparathyroidism with hyperparathyroidism. Methods: A total of 32 glands with severe MHD secondary hyperparathyroidism (SHPT) underwent ultrasound-guided microwave ablation under local anesthesia. The total parathyroid glands (i PTH) before and after ablation were observed. Calcium and phosphorus levels, and to assess the accompanying symptoms of pruritus, pain and other relief and ablation-related side effects. Results: The serum levels of i PTH and calcium and phosphorus in 10 patients were significantly decreased at 1, 2, 1, 3 months postoperatively, with significant difference (P <0.05); The rate of descending i PTH was> 30% in 10 cases, accounting for 100%. The preoperative serum i PTH level was above 4 000 pg / ml, and remained high after operation. However, the symptoms such as pain and pruritus were relieved significantly. 2 For example, serum i PTH increased to over 600 pg / ml at 3 months postoperatively and dropped below 300 pg / ml after treatment with active vitamin D and other drugs. Two patients (20%) had hoarseness after operation, both of which were relieved within 1 month. No tracheal, esophageal, vascular and neck muscle injuries were found in all cases and no infection occurred. Conclusion: Microwave-guided thermal ablation of MHD patients with severe secondary hyperparathyroidism, short-term effect is accurate, safe, less trauma and fewer complications, is a worthy of the promotion of a new method of clinical treatment.