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  • 陶林波,章建全,蒋霞,蒋小燕,沈浩.微波消融治疗前臂甲状旁腺移植组织功能亢进2例并文献复习[J].第二军医大学学报,2018,39(11):1240-1245    [点击复制]
  • TAO Lin-bo,ZHANG Jian-quan,JIANG Xia,JIANG Xiao-yan,SHEN Hao.Microwave ablation for hyperparathyroidism of forearm transplanted autograft: a report of two cases and review of literature[J].Acad J Sec Mil Med Univ,2018,39(11):1240-1245   [点击复制]
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微波消融治疗前臂甲状旁腺移植组织功能亢进2例并文献复习
陶林波1,章建全2*,蒋霞3,蒋小燕1,沈浩4
0
(1. 南通市第二人民医院超声科, 南通 226002;
2. 海军军医大学(第二军医大学)长征医院超声诊疗科, 上海 200003;
3. 南通市第二人民医院肾内科, 血液透析中心, 南通 226002;
4. 南通市中医院超声科, 南通 226001
*通信作者)
摘要:
目的 探讨超声引导下微波消融治疗前臂甲状旁腺移植组织功能亢进的效果及技术安全性。方法 2例曾行甲状旁腺全切除联合自体组织移植术(PTX+AT)并行维持性血液透析的患者,因血清全段甲状旁腺激素(iPTH)水平显著升高及伴发症状加重,确诊为前臂甲状旁腺移植组织功能亢进。对移植物进行多模态高频超声检查并行超声引导下经皮微波消融术治疗,观察患者术后疗效和临床症状。结果 超声检查清晰显示2例患者前臂甲状旁腺移植组织的位置、数量、大小、血流灌注状态。测定2例患者各移植组织内iPTH水平后,保留测定值最低的1枚,其余均实施微波消融术,消融治疗均获技术成功。2例患者共消融前臂甲状旁腺移植组织分别为5枚和4枚,最大者分别为15 mm×6 mm和13 mm×5 mm。2例患者微波消融术后1 d移植侧、非移植侧前臂静脉血iPTH水平分别为87.3 ng/L、79.6 ng/L和66.3 ng/L、65.2 ng/L。术后1年随访期间患者钙、磷、碱性磷酸酶水平均下降并持续稳定,骨和关节痛明显缓解,且未出现移植侧前臂皮肤感觉麻木以及指、腕关节的屈伸活动异常。结论 PTX+AT后前臂甲状旁腺移植组织可发生功能亢进,微波消融可有效治疗移植组织功能亢进,其操作简便且安全性高。
关键词:  甲状旁腺切除术  自体移植  组织移植  前臂甲状旁腺移植组织功能亢进  微波消融术  介入性超声检查
DOI:10.16781/j.0258-879x.2018.11.1240
投稿时间:2018-05-20修订日期:2018-08-17
基金项目:国家自然科学基金(81171436).
Microwave ablation for hyperparathyroidism of forearm transplanted autograft: a report of two cases and review of literature
TAO Lin-bo1,ZHANG Jian-quan2*,JIANG Xia3,JIANG Xiao-yan1,SHEN Hao4
(1. Department of Ultrasound, The Second People's Hospital of Nantong, Nantong 226002, Jiangsu, China;
2. Department of Ultrasound, Changzheng Hospital, Navy Medical University(Second Military Medical University), Shanghai 200003, China;
3. Department of Nephrology, Center of Blood Purification, The Second People's Hospital of Nantong, Nantong 226002, Jiangsu, China;
4. Department of Ultrasound, Nantong Hospital of Traditional Chinese Medicine, Nantong 226001, Jiangsu, China
*Corresponding author)
Abstract:
Objective To explore the treatment effect and technical safety of ultrasound-guided microwave ablation for hyperparathyroidism of forearm transplanted autograft. Methods Two patients who had undergone parathyroidectomy with autotransplantation (PTX+AT) and maintenance hemodialysis were diagnosed as having hyperparathyroidism of forearm transplanted autograft based on the increased serum intact parathyroid hormone (iPTH) and aggravated accompanying symptoms. The multimodal high frequency ultrasound was performed to examine the autografts, and ultrasound-guided percutaneous microwave ablation was used to treat the hyperparathyroidism of the patients. Curative effect and symptoms of the patients were observed after treatment. Results Ultrasonography clearly showed the location, number, size and blood perfusion of the parathyroid gland autografts in the forearm of the two patients. After measuring the levels of iPTH in the transplanted tissues of the two patients, one with the lowest iPTH level was retained and the others were treated with microwave ablation, and the ablation treatment was technically successful. In the two patients, 5 and 4 parathyroid gland autografts were ablated and the largest ones were 15 mm×6 mm and 13 mm×5 mm, respectively. The levels of iPTH on the graft side and non-graft side were 87.3 ng/L and 79.6 ng/L, and 66.3 ng/L and 65.2 ng/L after 1 day of microwave ablation, respectively. During the follow-up period of 1 year after microwave ablation, calcium, phosphorus and alkaline phosphatase levels of the two patients were decreased and remained stable, bone and joint pains were relieved, and no numbness or abnormal movement of fingers and wrist joints were found in the transplanted side. Conclusion Hyperparathyroidism of forearm transplanted autograft can occur after PTX+AT. Microwave ablation is effective and safe in the treatment of the hyperparathyroidism.
Key words:  parathyroidectomy  autologous transplantation  tissue transplantation  hyperparathyroidism of forearm transplanted autografts  microwave ablation  interventional ultrasonography