ISSN 1006-298X      CN 32-1425/R

导航

肾脏病与透析肾移植杂志 ›› 2017, Vol. 26 ›› Issue (4): 370-375.DOI: 10.3969/j.issn.1006-298X.2017.04.016

• 论文 • 上一篇    下一篇

甲状旁腺热消融术治疗严重继发性甲状旁腺功能亢进

  

  • 出版日期:2017-08-28 发布日期:2017-09-04

Thermal ablation in the management of severe secondary hyperparathyroidism

  • Online:2017-08-28 Published:2017-09-04

摘要:

继发性甲状旁腺功能亢进(SHPT)作为慢性肾脏病矿物质骨代谢异常(CKDMBD)的一个重要临床表现,可引起骨骼病变、心血管并发症等,严重影响患者的长期生存和生活质量。目前对于SHPT的治疗主要包括限制含磷食物的摄入、透析方式的调整、磷结合剂、活性维生素D、钙敏感受体激动剂的使用等。甲状旁腺切除手术(PTX)仍是目前对药物抵抗的严重SHPT患者首选治疗方式。然而有部分患者因存在严重心肺功能障碍、无法耐受全身麻醉或曾反复行颈部手术等原因无法进行PTX,为控制病情,超声引导下经皮甲状旁腺热消融术成为患者的另一选择。本文总结了该疗法在严重SHPT患者中的操作流程、注意事项、临床运用及研究进展。

Abstract:

As a major part of the chronic kidney diseasemineral and bone disorder (CKDMBD),secondary hyperparathyroidism (SHPT) leads to skeletal and cardiovascular diseases, which affects the long term survival and life quality of patients. Current treatments for SHPT include dietary phosphorus restriction, modification of dialysis prescription, phosphate binders, calcitriol or vitamin D analogues, and calcimimetics. Parathyroidectomy (PTX) should be taken into account when pharmacologic therapy has failed either because of drug resistance or side effects. However, patients with serious cardiac and/or pulmonary comorbidities are at increased risk of complications of general anesthesia. In addition, reoperation in the neck region may be difficult. To alleviate clinical symptoms, thermal ablation can be introduced as a treatment alternative. This paper summarizes the operation procedure and precautions of this treatment modality for patients with severe SHPT as well as its clinical application and recent development.