甲狀旁腺全切除+前臂自體移植術對腎功能衰竭繼發甲狀旁腺功能亢進合并關節周圍軟組織鈣化患者的療效分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

張智 ¹ , 李建文 ¹ , 陳偉杰 ¹ , 黎思毅 ¹ , 許托 ¹ , 覃文懿 ¹ , 蔡文松 ² ,  徐波 ²

1. ;
2. ;

Corresponding?author：

徐波, Email: aabb97@163.com

Keywords：

甲狀旁腺全切除+前臂自體移植術; 腎臟功能衰竭繼發甲狀旁腺功能亢進; 關節周圍軟組織鈣化; 療效

DOI：

10.7507/1007-9424.201709015

Video：

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目的探討甲狀旁腺全切除+前臂自體移植術（TPT+AG）對腎臟功能衰竭（簡稱腎衰）繼發甲狀旁腺功能亢進（簡稱甲旁亢）患者關節周圍軟組織鈣化的療效。方法回顧性分析廣東醫科大學附屬醫院 2015 年 4 月至 2017 年 4 月期間收治的 11 例腎衰繼發甲旁亢合并關節周圍軟組織鈣化患者的臨床資料，均采用 TPT+AG 治療，比較手術前后血清甲狀旁腺激素（PTH）、鈣、磷水平、鈣磷乘積變化情況，并觀察術后關節周圍軟組織鈣化改善的情況。結果 11 例患者術后第 6 個月時血磷、鈣磷乘積均在正常范圍內，有 10 例患者在術后 6 個月于體表均未及原有腫物，臨床觀察腫物消失最短時間為 2 個月，其原有的活動障礙、局部麻木、疼痛等不適癥狀完全消失，僅 1 例患者術后肘關節腫物縮小不明顯。結論本研究有限病例的初步研究結果提示，對于腎衰繼發甲旁亢合并關節周圍軟組織鈣化的患者，TPT+AG 是有效的治療方法，患者可能僅通過 TPT 就可使關節周圍軟組織鈣化明顯縮小或者完全消除。

Citation： 張智, 李建文, 陳偉杰, 黎思毅, 許托, 覃文懿, 蔡文松, 徐波. 甲狀旁腺全切除+前臂自體移植術對腎功能衰竭繼發甲狀旁腺功能亢進合并關節周圍軟組織鈣化患者的療效分析. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(2): 225-228. doi: 10.7507/1007-9424.201709015 Copy

1.	Tentori F, Blayney MJ, Albert JM, et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis, 2008, 52(3): 519-530.
2.	Moe S, Drüeke T, Cunningham J, et al. Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int, 2006, 69(11): 1945-1953.
3.	Floege J, Kim J, Ireland E, et al. Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population. Nephrol Dial Transplant, 2011, 26(6): 1948-1955.
4.	Raggi P, Boulay A, Chasan-Taber S, et al. Cardiac calcification in adult hemodialysis patients. A link between end-stage renal disease and cardiovascular disease? J Am Coll Cardiol, 2002, 39(4): 695-701.
5.	de Alarcón RM, Palomares M, Marfil A, et al. Posttransplant regression of uremic tumoral calcinosis.Nefrologia, 2007, 27(3): 378-381.
6.	Baek D, Lee SE, Kim WJ, et al. Greater trochanteric pain syndrome due to tumoral calcinosis in a patient with chronic kidney disease. Pain Physician, 2014, 17(6): E775-E782.
7.	Xu Z, Tang C, Zhang L, et al. Multiple ectopic calcification in subcutaneous tissues detected by bone scintigraphy in a patient with chronic renal failure. Clin Nucl Med, 2015, 40(6): 512-514.
8.	周建平, 李曉莉, 董明, 等. 我國原發性甲狀腺功能亢進癥的誤診情況分析. 中國現代醫學雜志, 2006, 16(7): 1040-1042.
9.	Yang H, Curinga G, Giachelli CM. Elevated extracellular calcium levels induce smooth muscle cell matrix mineralization in vitro. Kidney Int, 2004, 66(6): 2293-2299.
10.	Kapustin AN, Davies JD, Reynolds JL, et al. Calcium regulates key components of vascular smooth muscle cell-derived matrix vesicles to enhance mineralization. Circ Res, 2011, 109(1): e1-e12.
11.	Sunder S, Verma H, Venkataramanan K. Cervical tumoral calcinosis with secondary hyperparathyroidism in a chronic hemodialysis patient. Hemodial Int, 2013, 17(3): 458-462.
12.	曲建坤, 王兆新, 王焱. 甲狀旁腺切除對繼發性甲狀旁腺功能亢進的維持性血透患者左心功能及生存質量的影響. 臨床心血管病雜志, 2015, 31(10): 1078-1081.
13.	Latif F, Khalid MM, Khan F, et al. Role of hyperphosphatemia-mediated vascular calcification in cardiovascular outcomes and its management: a review. J Cardiovasc Med (Hagerstown), 2013, 14(6): 410-415.
14.	Binnani P, Aggarwal V, Bahadur MM, et al. Tumoral calcinosis (Teutschlander disease) in a dialysis patient. Indian J Nephrol, 2008, 18(3): 122-124.
15.	廖常志, 張靜, 何強. 等. 慢性腎臟病患者血清 iPTH 及鈣磷異常的發生率. 四川醫學, 2011, 32(9): 1338-1340.
16.	Niemann KE, Kr?pil F, Hoffmann MF, et al. A 23-year-old patient with secondary tumoral calcinosis: Regression after subtotal parathyroidectomy: A case report. Int J Surg Case Rep, 2016, 23: 56-60.

1. Tentori F, Blayney MJ, Albert JM, et al. Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis, 2008, 52(3): 519-530.
2. Moe S, Drüeke T, Cunningham J, et al. Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int, 2006, 69(11): 1945-1953.
3. Floege J, Kim J, Ireland E, et al. Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population. Nephrol Dial Transplant, 2011, 26(6): 1948-1955.
4. Raggi P, Boulay A, Chasan-Taber S, et al. Cardiac calcification in adult hemodialysis patients. A link between end-stage renal disease and cardiovascular disease? J Am Coll Cardiol, 2002, 39(4): 695-701.
5. de Alarcón RM, Palomares M, Marfil A, et al. Posttransplant regression of uremic tumoral calcinosis.Nefrologia, 2007, 27(3): 378-381.
6. Baek D, Lee SE, Kim WJ, et al. Greater trochanteric pain syndrome due to tumoral calcinosis in a patient with chronic kidney disease. Pain Physician, 2014, 17(6): E775-E782.
7. Xu Z, Tang C, Zhang L, et al. Multiple ectopic calcification in subcutaneous tissues detected by bone scintigraphy in a patient with chronic renal failure. Clin Nucl Med, 2015, 40(6): 512-514.
8. 周建平, 李曉莉, 董明, 等. 我國原發性甲狀腺功能亢進癥的誤診情況分析. 中國現代醫學雜志, 2006, 16(7): 1040-1042.
9. Yang H, Curinga G, Giachelli CM. Elevated extracellular calcium levels induce smooth muscle cell matrix mineralization in vitro. Kidney Int, 2004, 66(6): 2293-2299.
10. Kapustin AN, Davies JD, Reynolds JL, et al. Calcium regulates key components of vascular smooth muscle cell-derived matrix vesicles to enhance mineralization. Circ Res, 2011, 109(1): e1-e12.
11. Sunder S, Verma H, Venkataramanan K. Cervical tumoral calcinosis with secondary hyperparathyroidism in a chronic hemodialysis patient. Hemodial Int, 2013, 17(3): 458-462.
12. 曲建坤, 王兆新, 王焱. 甲狀旁腺切除對繼發性甲狀旁腺功能亢進的維持性血透患者左心功能及生存質量的影響. 臨床心血管病雜志, 2015, 31(10): 1078-1081.
13. Latif F, Khalid MM, Khan F, et al. Role of hyperphosphatemia-mediated vascular calcification in cardiovascular outcomes and its management: a review. J Cardiovasc Med (Hagerstown), 2013, 14(6): 410-415.
14. Binnani P, Aggarwal V, Bahadur MM, et al. Tumoral calcinosis (Teutschlander disease) in a dialysis patient. Indian J Nephrol, 2008, 18(3): 122-124.
15. 廖常志, 張靜, 何強. 等. 慢性腎臟病患者血清 iPTH 及鈣磷異常的發生率. 四川醫學, 2011, 32(9): 1338-1340.
16. Niemann KE, Kr?pil F, Hoffmann MF, et al. A 23-year-old patient with secondary tumoral calcinosis: Regression after subtotal parathyroidectomy: A case report. Int J Surg Case Rep, 2016, 23: 56-60.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

甲狀旁腺全切除+前臂自體移植術對腎功能衰竭繼發甲狀旁腺功能亢進合并關節周圍軟組織鈣化患者的療效分析

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