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目的研究微波消融持续/复发性继发甲旁亢(SHPT)的安全性与有效性。方法 19例入组患者24个SHPT结节行微波消融,消融后超声造影评估疗效。对比消融前后患者全段甲状旁腺激素(iPTH)及血钙、血磷、碱性磷酸酶(ALP)测值变化,记录并发症发生情况。结果所有24个持续/复发性SHPT结节消融后超声造影为无增强。术后iPTH由术前(1 376±1 359)pg/ml降为术后1d(254±235)pg/ml(P<0.01)和随访终点(345±362)pg/ml(P<0.01);血钙由术前(2.48±0.21)mmol/L降为(2.15±0.25)mmol/L(P<0.01)和(2.32±0.22)mmol/L(P<0.05);血磷由术前(2.09±0.70)mmol/L降为(1.78±0.60)mmol/L(P<0.01)和(1.44±0.38)mmol/L(P<0.01);消融前后ALP测值无统计学差异(P>0.05)。1例患者(5.3%)发生一侧喉返神经损伤,随访期内[3~24个月,平均(14.2±7.3)d]无其他并发症发生。结论微波消融作为一种微创技术治疗持续/复发性SHPT是安全和有效的。
Objective To study the safety and efficacy of continuous / recurrent secondary hyperparathyroidism (SHPT) after microwave ablation. Methods Twenty - four SHPT nodules of 19 patients underwent microwave ablation and contrast echocardiography after ablation. Before and after ablation of patients with parathyroid hormone (iPTH) and serum calcium, phosphorus, alkaline phosphatase (ALP) measured changes in the incidence of complications were recorded. Results All 24 consecutive / recurrent SHPT nodules were ablated with contrast-enhanced ultrasound. The postoperative iPTH decreased from (376 ± 1 359) pg / ml preoperatively to (254 ± 235) pg / ml postoperatively (P <0.01) (2.15 ± 0.25) mmol / L and (2.32 ± 0.22) mmol / L respectively (2.48 ± 0.21 mmol / L, P <0.01) 2.09 ± 0.70) mmol / L (1.78 ± 0.60) mmol / L and (1.44 ± 0.38) mmol / L respectively (P <0.01), but there was no significant difference between before and after ablation ). One patient (5.3%) developed recurrent laryngeal nerve injury. No other complication occurred during the follow-up period of [3-24 months (mean, 14.2 ± 7.3) days]. Conclusion Microwave ablation as a minimally invasive technique for the treatment of persistent / recurrent SHPT is safe and effective.