中文摘要：

目的 分析3种外科手术方式治疗继发性甲状旁腺功能亢进的短期及长期疗效.方法 回顾性分析自2004年10月至2014年10月于上海交通大学医学院附属仁济医院因继发性甲状旁腺功能亢进行甲状旁腺切除的病例共88例.病例分为3组,组Ⅰ行甲状旁腺次全切除术,组Ⅱ行甲状旁腺全切＋前臂移植术,组Ⅲ行99锝标记的甲氧基异丁基异腈（99Tcm-MIBI）引导下的甲状旁腺全切＋前臂移植术.收集3组病例术前、术后短期（≤6个月）及术后长期（＞6个月）的血钙、血磷、血甲状旁腺素（PTH）的结果及临床症状改善程度和术后复发率及并发症等资料.结果 3组术后临床症状均较术前有明显改善.组Ⅰ和组Ⅱ术后短期内血钙、血PTH及术后短期复发率差异均无统计学意义.组Ⅲ术后短期内血钙、血PTH及术后短期复发率均低于组Ⅰ及组Ⅱ,差异均有统计学意义（P值均＜0.05）.3组术后血磷值差异无统计学意义.组Ⅲ手术时间明显短于组Ⅱ,差异有统计学意义[（77±13） min比（108±17） min,P＜0.05].组Ⅲ切除的甲状旁腺阳性率高于组Ⅱ,差异有统计学意义（98.5％比88.7％,P＜0.05）.经过长期随访,组Ⅰ与组Ⅱ的术后血钙、血磷、血PTH及术后复发率差异均无统计学意义.组Ⅲ的术后复发率均低于组Ⅰ及组Ⅱ的术后复发率,差异均有统计学意义（3.6％比31.6％、21.4％,P值均＜0.05）.结论 治疗继发性甲状旁腺功能亢进,甲状旁腺全切＋前臂移植有着较好的疗效,而99Tcm-MIBI引导下的甲状旁腺全切＋前臂移植术则可更好的发现异位及额外的甲状旁腺,提高手术成功率,同时术中可无需等待冰冻病理,缩短手术时间.在术后随访中,复发率也较低,是一种安全及有效的治疗方式.

英文摘要：

Objective To analyze the short-term and long-term outcomes of the three operation methods in treatment of secondary hyperparathyroidism.Methods Clinical data of 88 patients who underwent parathyroidectomy for secondary hyperparathyroidism from October 2004 to October 2014 were reviewed retrospectively.Patients were divided into three subgroups,including subtotal parathyroidectomy （group Ⅰ）,total parathyroidectomy with autotransplantation （group Ⅱ） and intraoperative 99Tcm-MIBI radioguided total parathyroidectomy with autotransplantation （group Ⅲ）.Their serum calcium,phosphorus,serum iPTH results in the pre-operation,short-term （≤ 6 months） and long term （〉 6 months） of postoperation were collected and compared.The improvements of clinical symptoms together with the postoperative recurrence rate and the complication data were observed and analyzed.Results The symptoms of all patients were improved after the operation.The short-term postoperative serum calcium,serum iPTH and recurrence rate of Group Ⅰ and group Ⅱ were all not statistically significant.The short-term postoperative serum calcium,iPTH and recurrence rate of group Ⅲ were significantly lower than those of group Ⅰ and group Ⅱ （P 〈 0.05）.Postoperative serum phosphorus values of the three groups had no statistical difference.The operation time of group Ⅲ was significantly shorter than that of group Ⅱ （（77 ± 13）vs （108 ± 17） min,P 〈 0.05）.The positive rates were more accurate in group Ⅲ than in group Ⅱ （98.5% vs 88.7%,P 〈 0.05）.For the long term follow-up,the postoperative serum calcium,phosphorus,serum iPTH and recurrence rate of group Ⅰ and group Ⅱ were not statistically different.The postoperative recurrence rate of group Ⅲwas lower than that of group Ⅰ and group Ⅱ （3.6% vs 31.6% and 21.4% respectively,P 〈 0.05）.Conclusions Total parathyroidectomy with autotransplantation has a good efficacy to treat secondary hyperparathyroidism.The intraoperative 99Tcm-MIBI radi