Evaluation Of Purge Parathyroidectomy And Subcutaneous Forearm Autotransplantation In Treatment Of Secondary Hyperparathyroidism

Objective The study was conducted to investigate the clinical efficacy of purge parathyroidectomy with forearm subcutaneous autotransplantation(pptx+at)in treatment of secondary hyperparathyroidism(SHPT).Methods A total of 59 SHPT patients including 9 cases treated with total parathyroidectomy(tptx)and 50 cases treated with pptx+at in China Japan Friendship Hospital of Jilin University from February 2017 to September 2019 were analyzed retrospectively.The safety and effectiveness of pptx+at were evaluated by comparing the operation time,the resection number of parathyroids,postoperative complications and recurrence rate between the two groups.Biochemical parameters before and 1day、1 month、3months、6 months post operation、preoperative and postoperative SF-36 score of health survey form as well as bone mineral density(BMD)before and 1 month、3months、6 months、12 months after operation were detected to evaluate the clinical efficacy of pptx+at in treatment of SHPT.The correlation between dialysis age,preoperative blood calcium,iPTH,ALP,intraoperative PTH decrease rate[(venous serum iPTH before operation-iPTH 30 minutes after operation)/venous serum iPTH before operation]with postoperative hypocalcemia were analyzed.Results 1.The success rate of group pptx+at was 100%,and that of group tptx was88.88%,the difference was not statistically significant;the excision number of parathyroids in group pptx+at was more than that in group tptx,the difference was statistically significant(P=0.002);the operation time of the two groups was(146.40±26.26)mins and(138.33±13.92)mins respectively,the difference was not statistically significant;the incidence of recurrent laryngeal nerve injury and hypocalcemia in the two groups was not statistically significant.2.The serum calcium,phosphorus,iPTH and ALP decreased significantly at postoperative each time points(P＜0.01).3.The quality of life in half a year after operation was significantly improved compared with that before operation.4.BMD increased as early as 1 month after operation(P=0.002).BMD of 3months,6 months and 12 months after operation was significantly higher than that before operation(P＜0.05).BMD of one patient was lower than that before operation at 24 months after operation.5.Postoperative serum calcium was correlated with preoperative serum calcium(r_s=0.392,P=0.009),IPH(r_s=-0.630,P=0.000)and ALP(r_s=-0.611,P=0.000).6.The postoperative persistence or recurrence SHPT rate(0%)in the PPTX+AT group was lower than that in the TPTX group(22.22%),the difference was statistically significant(P=0.021).The survival rate of the subcutaneous forearm graft in the PPTX+AT group was 94%.Conclusion Compared with tptx,pptx+at did not significantly increase the operation time and complications,and did better in the number of parathyroid excision.Pptx+at can significantly improve the blood biochemical indexes and quality of life of SHPT patients.The BMD value increased significantly after operation.Osteoporosis was corrected from 1 month after operation.Preoperative hypocalcemia,high iPTH and high ALP indicate high possibility of hypocalcemia after operation.The technique for forearm subcutaneous transplantation with multiple separate pockets guarantees the high survival rate and low recurrence rate.Pptx+at is safe and effective in the treatment of SHPT,and may have more advantages than traditional operation.