| Objective: To analyze secondary hyperparathyroidism in patients with perioperative calcium curve changes, and find the law, and visit patients taking calcium dose, in order to assess the effect of surgery.Methods: A retrospective analysis of the First Affiliated Hospital of Wannan Medical hemodialysis center since June 2012 to January 2015 in 31 cases due to failure of medical treatment and the choice of surgical treatment of secondary hyperparathyroidism in patients with information, patients aged 18-56years(Average43.2yearsold),Statistics patients’ serum calcium value before surg ery, in the first day after surgery, the first three days after surgery, the first seven days after surgery and a month later after surgery.Statistics patients’ Blood calcium and pho sphorus product before surgery and after surgery.Statistics i PTH value of peripheral bl ood before surgery and after surgery a month i PTH value of peripheral blood.By com paring peripheral blood i PTH value before and after surgery to assess the effect of sur gery and draws calcium change curve.Combined with interviews after surgery, to dev elop an appropriate calcium solutions for patients, to further improve the quality of lif e of patients.Result:31 patients were successfully operated, one patient to do is cut the whole parat hyroid surgery plus autologous transplants(total PTX with autotransplantation, TPTX + AT), 14 patients with the whole parathyroid resection without transplant surgery(to tal PTX without autotransplantation, TPTX), 16 patients underwent subtotal parathyro idectomy operation(subtotal parathyroidectomy, SPTX). before surgery 31 patients bl ood calcium average(2.57 ± 0.23) mmol / L, the average calcium during surgery(2.28 ± 0.19) mmol / L, the first day after surgery, the mean serum calcium(1.94 ± 0.26) mmol / L, after surgery The first three days of calcium average(1.75 ± 0.21) mmol / L, the first seven days after surgery calcium average(1.93 ± 0.20) mmol / L, one month after surgery calcium average(2.30 ± 0.31) mmol / L, before surgery The average blo od phosphorus product(66.34 ± 15.74) mmol2 / L2, after surgery,the average blood p hosphorus product(34.79 ± 13.08) mmol2 / L2, pre-operative i PTH average(1795.40 ± 512.61) pg / ml, 1 month after surgery surgery average(37.27 ± 86.67) pg / ml. The results by statistical analysis comparing 31 cases of postoperative serum calcium, pho sphorus product lower than before surgery, 29 cases of patients were significantly low er than the preoperative i PTH, two cases of postoperative i PTH> 100 pg / ml, which o ne case of normal calcium and phosphorus, one case a little high calcium, but somew hat lower than before the surgery. Surgical resection of parathyroid total 116, of which 23 patients had four parathyroid(74%), 8 patients had three adjacent glands(26%), p ost-operative pathology Display: 7 showed diffuse proliferative(6.03%), 96 nodular h yperplasia(82.76%), 13 were adenomatous hyperplasia formation(11.21%), of which there are three parathyroid hyperplasia with calcification, there are two cases with pa pillary thyroid carcinoma, after the operation there was no hoarseness, bucking compl ications, 7 patients had obvious clinical manifestations of hypocalcemia, four patients had significantly low blood pressure, skin itching, pain and other symptoms disappear ed after operation.Conclusion:1patients will have a period of time to reduce blood calcium, blood calciu m enter bone, effectively improve the state of the bone calcium, delaying the occurre nce of associated complications;2, patients with calcium-phosphate product significan tly reduced compared with before surgery, reduces the risk of calcification of defense;3, after the status of the bones lack of calcium, the calcium will rise, patients taking ca lcium reduction from the previous surgery. Disable the use of shock therapy;4, PTH w as significantly reduced in patients after surgery than before. Surgery is an effective m eans of treatment of SHPT. |
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