Comparison Between Subtotal Parathyroidectomy And Total Parathyroidectomy With Autotransplantation For Secondary Hyperparathyroidism

Objective:Compare the short-term treatment effect of subtotal parathyroidectomy(s PTX)and total parathyroidectomy with autotransplantation(t PTX+AT)for chronic renal failure with secondary hyperparathyroidism.Methods:The clinical data of SHPT patients who received s PTX or t PTX+AT surgery from the First Hospital and Shengjing Hospital of China Medical University from April 2012 to March 2018 were collected.All patients were treated by our senior doctors.Patients who underwent initial surgery,had no other systemic cardiopulmonary disease and were able to access the electronic data were selected.According to their different surgical methods,they were divided into two groups(group A: patients underwent subtotal parathyroidectomy;group B: patients underwent total parathyroidectomy with autotransplantation).Statistical analysis of postoperative serum calcium,serum phosphorus,parathyroid hormone(i PTH)levels and other biochemical indicators and bone pain,itching and other symptoms of remission,also compare the postoperative hospital stay,operation time and other hospitalization indicator and recurrence rate.Results:A total of 54 patients were included in the study,including 24 patients in group A and 30 patients in group B.The clinical symptoms of bone pain and itching were all reduced or disappeared within 3 months.There was no significant difference between the two groups(P>0.05).The serum i PTH value,serum calcium value and serum phosphorus value of the two groups on 1 day,7 days,3 months,6months,and 1year after operation were significantly lower than those before operation(P<0.05).There was no significant difference in i PTH values between the two groups at various time points after operation.The serum calcium levels in group A were lower than those in group B on 1 day and 7 days after operation.There was no significant difference in serum calcium levels between the two groups in 3months,6 months and 1 year.There was no significant difference in serum phosphorus levels between the two groups on 1 day and 7 days after operation.The serum phosphorus levels of the two groups were different in 3 months,6 months and 1 year after surgery,but they all fluctuated within the normal range.The average operation time of group A was 91.25±16.70 min,and the average operation time of group B was 122.83±35.42 min.The operation time of group A was significantly lower than that of group B(P<0.05).The average hospital stay in group A was 4.83±2.16 days,the average hospital stay in group B was 10±7.33 days.The postoperative hospital stay in group A was significantly lower than that in group B(P<0.05).As follow-up in one year,2 of 24 patients in group A had recurrence,the recurrence rate was 8.3%,and 2 of 30 patients in group B had recurrence,the recurrence rate was 6.7%.There was no significant difference in recurrence rate between the two groups(P >0.05).Conclusion:Both s PTX and t PTX+AT are effective treatments for secondary hyperparathyroidism.It is similar that they relieve clinical symptoms,control serum calcium,serum phosphorus and i PTH levels,have clinical complications and postoperative recurrence.However,s PTX operation time and postoperative hospital stay are shorter,which may be a better choice for clinical treatment of SHPT.