【摘要】 目的 探讨超声引导下经皮微波消融治疗慢性肾脏病（chronic kidney disease,CKD）继发甲状旁腺功能亢进（secondary hyperparathyroidism,SHPT）的临床效果。方法 将2019年1月—2022年8月在梅州市人民医院治疗的90例CKD患者SHPT根据不同治疗方法进行分组，观察组（n=62）使用超声引导下经皮微波消融术，对照组（n=28）使用甲状旁腺切除术。对比两组的临床疗效、血全段甲状旁腺激素（intact parathyroid hormone,iPTH）及钙磷指标、症状评分、并发症。结果 两组手术成功率均为100%，观察组复发3例（4.84%），对照组复发1例（3.57%），差异无统计学意义（P> 0.05）；两组术后1 d、1周、1、3、6个月的iPTH、钙、磷均低于术前，术后1、3、6个月的碱性磷酸酶（alkaline phosphatase,ALP）低于术前（P <0.05），观察组iPTH高于对照组，ALP低于对照组，术后3、6个月钙水平高于对照组，术后1个周、1个月、3个月磷水平低于对照组（P <0.05）；观察组术后1、3、6个月的皮肤瘙痒、乏力、骨痛等症状评分均低于对照组（P <0.05）；观察组感染、声音嘶哑、甲状旁腺损伤、严重低血钙等并发症总发生率明显低于对照组（P <0.05）。结论 超声引导下经皮微波消融在治疗CKD患者SHPT的应用效果显著，创伤小，手术成功率高，并发症及复发率低，能有效降低iPTH，改善钙磷代谢，缓解临床症状。更多还原

【Abstract】 Objective To investigate the clinical effect of ultrasound-guided percutaneous microwave ablation in the treatment of secondary hyperparathyroidism(SHPT) in chronic kidney disease(CKD). Methods A total of 90 patients with CKD SHPT treated in Meizhou People’s Hospital from January 2019 to August 2022 were randomly divided into two groups, the observation group(n=62) used ultrasound-guided percutaneous microwave ablation, the control group(n=28) used parathyroidectomy,compared the two groups with the clinical efficacy, whole blood parathyroid hormone(intact parathyroid hormone, iPTH) and calcium and phosphorus index, symptom scores and complications. Results The success rate of both groups was 100%, 3 patients(4.84%) in observation group and 1 patient(3.57%), with no significant difference between groups(P > 0.05).In both groups, iPTH, calcium and phosphorus at 1 d, 1 week, 1, 3,and 6 months were lower than preoperative, and alkaline phosphatase(alkaline phosphatase, ALP) at 1, 3 and 6 months was lower than preoperative(P < 0.05), the observation group iPTH was higher than the control group, the ALP was lower than the control group, the calcium level of 3 months and 6 months was higher than the control group, and the phosphorus level of 1 week, 1 month and 3 month was lower than the control group(P < 0.05). The symptom scores of the observation group at 1 month, 3 months, and 6 months were lower than that of the control group(P < 0.05). The total incidence of complications such as infection, hoarseness, parathyroid injury,and severe hypocalcemia were significantly lower than that in the control group(P < 0.05). Conclusion Ultrasound-guided percutaneous microwave ablation has achieved remarkable results in the treatment of SHPT in CKD patients, with low trauma, high surgical success rate, low complication and recurrence rate, which can effectively reduce iPTH, improve calcium and phosphorus metabolism, and relieve clinical symptoms.更多还原