中国现代普通外科进展

目的：探讨超声引导下经皮微波消融与开放手术治疗原发性甲状旁腺功能亢进（PHPT）的疗效与安全性。方法：采用回顾性研究设计，选取武汉科技大学附属普仁医院2020年5月—2024年5月收治的160例PHPT患者，按治疗方式分为观察组（超声引导下经皮微波消融，n=80）和对照组（开放手术，n=80）。比较两组围手术期指标，骨代谢指标，血钙、磷、甲状旁腺激素（PTH）变化及生活质量改善情况。结果：两组住院时间、失血量、治愈率及并发症发生率差异无统计学意义（P>0.05），观察组手术时间明显短于对照组（P<0.05）。12个月时，两组骨密度及25-羟维生素D[25(OH)D]差异无统计学意义（P>0.05），观察组骨钙素（OC）、Ⅰ型胶原β羧基端肽（β-CTX）水平均高于对照组（P<0.05）。术后各时点观察组PTH水平高于对照组，第1、3、30、90天差异有统计学意义（P<0.05）;PTH、血钙、磷水平均随时间变化（P<0.05），磷水平组间交互作用差异有统计学意义（P<0.05）。12个月时，观察组甲状腺疾病生活质量问卷简明版（ThyPRO-39）症状评分、生活影响维度评分及总分均高于对照组（P<0.05）。≥24个月随访中，观察组2例、对照组1例复发（Log-rank P=0.610）;Cox分析显示，观察组复发风险与对照组差异无统计学意义（HR=1.763,95%CI:0.183～17.000,P=0.624）。24个月时观察组腰椎骨密度低于对照组（P<0.05）。结论：超声引导下经皮微波消融治疗PHPT具有创伤小、手术时间短、术后PTH恢复更平稳等优势，为开放手术的有效替代方案；在当前样本与随访下，其远期复发率与开放手术相近，但24个月腰椎骨密度略低，提示需加强长期骨健康监测与管理。

Objective: To evaluate the efficacy and safety of ultrasound-guided percutaneous microwave abl ation compared with open surgery in the treatment of primary hyperparathyroidism(PHPT). Methods: This study adopts a retrospective study design, a total of 160 patients with PHPT admitted to PuRen Hospital Affiliated to Wuhan University of Science and Technology from May 2020 to May 2024 were enrolled. Patients were divided into an observation group(ultrasound-guided percutaneous microwave ablation, n=80) and a control group(open surgery, n=80) based on treatment modality. Perioperative indicators, bone metabolism markers, serum calcium, phosphorus, PTH levels, and quality of life improvements were compared between groups. Results: No significant differences were found between the two groups in terms of hospitalization duration, blood loss, cure rate, and complication rate(P>0.05). The observation group had a significantly shorter surgical time than the control group(P<0.05). At 12 months, no significant differences in bone mineral density and 25-hydroxyvitamin D [25(OH)D] levels were observed between the two groups(P>0.05), while the observation group had significantly higher levels of osteocalcin(OC) and type I collagen β-carboxy-terminal telopeptide(β-CTX) than the control group(P<0.05). Postoperative PTH levels were higher in the observation group at all time points compared to the control group, with significant differences at 1, 3, 30, and 90 days(P<0.05). PTH, blood calcium, and phosphorus levels changed over time(P<0.05), with a significant interaction effect on phosphorus levels between the groups(P<0.05). At 12 months, the observation group had higher scores on the Thyroid Disease Quality of Life Questionnaire Short Form(ThyPRO-39) for symptoms, life impact dimensions, and total score compared to the control group(P<0.05). During the ≥24-month follow-up, 2 cases of recurrence occurred in the observation group and 1 in the control group(Log-rank P=0.610). Cox regression showed that the recurrence risk in the observation group was HR=1.763(95% CI: 0.183-17.000), with no significant difference(P=0.624). At 24 months, the observation group had lower lumbar bone mineral density than the control group(P<0.05). Conclusion: Ultrasound-guided percutaneous microwave ablation for PHPT offers advantages such as minimal trauma, shorter surgery time, and more stable postoperative PTH recovery, making it an effective alternative to open surgery. With the current sample size and follow-up period, the long-term recurrence rate is comparable to that of open surgery, although the lumbar bone mineral density at 24 months is slightly lower, suggesting the need for enhanced long-term bone health monitoring and management.