经皮乙醇注射治疗继发性甲状旁腺功能亢进

[Percutaneous ethanol injections in the treatment of secondary hyperparathyroidism].

作者信息

Kuzdak Krzysztof, Rybińska Agnieszka, Białas Maciej

机构信息

Endocrinological and General Surgery Department of Medical University of Lodz, Poland.

出版信息

Endokrynol Pol. 2005 Nov-Dec;56(6):891-6.

PMID:16821207

Abstract

INTRODUCTION

Renal insufficiency is the most common etiology of secondary hyperparathyroidism. In case of resistance for conservative treatment, methods of choice are surgical intervention or percutaneous ethanol injections.

AIM OF THE STUDY

The aim of the study was to evaluate usefulness of percutaneous ethanol injection therapy in the treatment of patients with secondary hyperparathyroidism.

MATERIAL AND METHODS

We performed percutaneous 96% ethanol injections under USG guideance in 51 patients: 22 women (mean age 49.6 years) and 29 men (46.6 yrs). The base level of parathormone was 689.35 pg/ml. We managed to visualize one parathyroid gland in 34 patients, 2 in 12, 3 in 5 patients. The mean volume of a single gland was 0,8 cm3. All the injections were performed with the use of needle number 6. We repeated injections in case of no effects. One injection was performed in 18 patients, 2 in 18, 3 in 13, 5 in 1 and 6 in 1 patient. Before and after the treatment patients were examined with USG, scintigraphy and densitometry. Serum levels of calcium (Ca), phosphorus (P), parathormone (PTH) and alkaline phosphatase (FA) activity were also obtained. The main criteria for success was decrease in parathormone level of 50% or more in comparison with pre-injection level or to less than 200 pg/ml.

RESULTS

In the whole group of patients after the first month, positive results were observed in 67%. There were no changes in 23%, and PTH level increased in 10%. After 6 months-positive results in 53%, no change in 35% and increase in 12%. We noted the best results in patients with PTH less than 800 pg/ml-72% of them had positive results after 1 as far as after the 6 month.

CONCLUSIONS

Percutaneous ethanol injections are valuable method of treatment of secondary hyperparathyroidism. The best results can be obtained if PTH level is less than 800 pg/ml, one parathyroid gland dominating over the rest is visualised in USG, and if patient responds after 1 or at least 2 injections.

摘要

引言

肾功能不全是继发性甲状旁腺功能亢进最常见的病因。对于保守治疗无效的情况，首选的方法是手术干预或经皮乙醇注射。

研究目的

本研究的目的是评估经皮乙醇注射疗法在治疗继发性甲状旁腺功能亢进患者中的有效性。

材料与方法

我们在超声引导下对51例患者进行了经皮96%乙醇注射，其中22例女性（平均年龄49.6岁），29例男性（46.6岁）。甲状旁腺激素的基础水平为689.35 pg/ml。我们成功在34例患者中可视化一个甲状旁腺，12例中可视化2个，5例中可视化3个。单个腺体的平均体积为0.8 cm³。所有注射均使用6号针头。如果没有效果则重复注射。18例患者注射1次，18例注射2次，13例注射3次，1例注射5次，1例注射6次。治疗前后对患者进行超声、闪烁扫描和骨密度测定检查。还获取了血清钙（Ca）、磷（P）、甲状旁腺激素（PTH）和碱性磷酸酶（FA）活性水平。成功的主要标准是与注射前水平相比甲状旁腺激素水平降低50%或更多，或降至低于200 pg/ml。