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中华介入放射学电子杂志 ›› 2020, Vol. 08 ›› Issue (04) : 326 -332. doi: 10.3877/cma.j.issn.2095-5782.2020.04.007

所属专题: 文献

血管介入

继发性肾源性异位甲状旁腺功能亢进的介入栓塞治疗
张慧涛1, 张永裕1, 刘伙亮2, 胡晓俊1, 贺嘉男1, 甘海润1, 庞鹏飞1,()   
  1. 1. 519000 广东珠海,中山大学附属第五医院介入医学中心介入血管外科
    2. 510000 广东广州,广州医科大学附属中医医院肾内科
  • 收稿日期:2020-09-27 出版日期:2020-11-25
  • 通信作者: 庞鹏飞

Interventional embolization of secondary nephrogenic ectopic hyperparathyroidism

Huitao Zhang1, Yongyu Zhang1, Huoliang Liu2, Xiaojun Hu1, Jianan He1, Hairun Gan1, Pengfei Pang1,()   

  1. 1. Department of Interventional Vascular Surgery, Interventional Medical Centre, the Fifth Affiliated Hospital of Sun Yat-sen University, Guangdong Zhuhai 519000
    2. Department of Nephrology, the Affiliated TCM Hospital of Guangzhou Medical University, Guangdong Guangzhou 510000, China
  • Received:2020-09-27 Published:2020-11-25
  • Corresponding author: Pengfei Pang
  • About author:
    Corresponding author: Pang Pengfei, Email:
引用本文:

张慧涛, 张永裕, 刘伙亮, 胡晓俊, 贺嘉男, 甘海润, 庞鹏飞. 继发性肾源性异位甲状旁腺功能亢进的介入栓塞治疗[J/OL]. 中华介入放射学电子杂志, 2020, 08(04): 326-332.

Huitao Zhang, Yongyu Zhang, Huoliang Liu, Xiaojun Hu, Jianan He, Hairun Gan, Pengfei Pang. Interventional embolization of secondary nephrogenic ectopic hyperparathyroidism[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2020, 08(04): 326-332.

目的

探讨介入栓塞治疗继发性肾源性异位甲状旁腺功能亢进的有效性、安全性及可行性。

方法

术前通过高频超声、99mTc-MIBI甲状旁腺核素显像、增强CT或增强MRI检查评估异位甲状旁腺的解剖位置及动脉血供情况,采用介入栓塞的方式阻断其供血动脉,从而使其逐渐缺血坏死失去功能。

结果

第1例患者的异位甲状旁腺通过介入栓塞治疗后,其甲状旁腺素(parathyroid hormone,PTH)水平迅速下降,血钙、血磷亦迅速下降,皮肤瘙痒、周身骨痛等临床症状明显缓解;第2例患者因供血动脉显示不清,加之术中难以配合,仅完成部分血管栓塞,其PTH、血钙、血磷等指标呈一过性下降,但最终疗效不佳。

结论

介入栓塞治疗异位甲状旁腺是一种创伤小、操作简便、疗效相对可靠、安全性高的方法,成功的关键是术前明确定位及供血动脉,术中尽量完全栓塞其供血动脉,但其长期有效性尚需进一步评价。

Objective

To investigate the efficacy, safety and feasibility of interventional embolization in the treatment of secondary nephrogenic ectopic hyperparathyroidism.

Methods

The anatomic location and arterial blood supply of ectopic parathyroid gland were evaluated by high frequency ultrasound, 99mTc-MIBI parathyroid radionuclide imaging, enhanced CT or enhanced MRI before operation, and the supplying artery was blocked by interventional embolization, resulting in gradual ischemic necrosis and loss of function.

Results

After interventional embolization, the level of parathyroid hormone (PTH) decreased rapidly, the serum calcium and phosphorus also decreased rapidly, and the clinical symptoms such as skin pruritus and general bone pain were obviously relieved in one case.In another case, because of the blood supply artery was not clear and it was difficult to cooperate during the operation, only part of the vascular embolization was completed, and the indexes such as PTH, serum calcium and phosphorus decreased temporarily, but the final effect was not good.

Conclusions

Interventional embolization for the treatment of ectopic parathyroid is a minimally invasive, simple, reliable and safe method. The key to success is to clear the anatomic location and arterial blood supply of ectopic parathyroid gland before operation and to completely embolize the blood supply during operation, but its long-term effectiveness needs further evaluation.

图1 患者1术前右肩关节及骨盆平片,可见骨质疏松明显,多发骨折
图2 患者1 SPECT检查图像
图3 患者2 SPECT检查图像
图4 患者1增强CT检查图像
图5 患者2 CT扫描、核素断层显影像及融合图像
图6 患者2增强MRI检查图像
图7 患者1异位甲状旁腺DSA造影图像
图8 患者2异位甲状旁腺DSA造影图像
表1 患者1血清指标变化状况
表2 患者2血清指标变化状况
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