Observation Of The Clinical Efficacy Of Different Autologous Transplantation Volume In The Treatment Of Renal Secondary Hyperparathyroidism During Total Parathyroidectomy With Autotransplantation

Objective:To observe whether there is a difference in the clinical efficacy of different autologous transplantation amounts in the treatment of renal secondary hyperparath-yroidism(SHPT)in total parathyroidectomy with autotransplantation(TPTX+AT).Methods:A sum of 129 dialysis patients who successfully proceeded TPTX+AT in the Second Hospital of Anhui Medical University from May 17,2017 to June 19,2018 and were picked and carry through for the study.According to the amount of different parathyroid tissue of autologous transplantation,the patients were divided into group A:TPTX+AT(4 grains 1×1×1 mm~3)and group B:TPTX+AT(4 grains 2×2×2 mm~3).Postoperative serum indicators such as calcium(Ca),phosphorus(P),parathyroid hormone(PTH)and alkaline phosphatase(ALP)were contrasted in both groups,as well as the improvement of clinical features and the recurrence of SHPT.Results:1.Ca,P,PTH and ALP decreased significantly in both groups at postoperative3 months,6 months,1 year and 2 years(P<0.05).PTH at postoperative 1 year and Ca,P and PTH at postoperative 2 years in group B were significantly increased compared with group A(P<0.05),and there were no statistically significant differences in the remaining indicators at the remaining time points(P>0.05).2.Bone pain,pruritus,restless leg syndrome and sleep disorder were improved in the two groups 2 years after surgery(P<0.05),and there was no statistical difference in both groups(P>0.05).3.The recurrence rate of SHPT in group A was 2.38%(1/42),and the recurrence rate of SHPT in group B was 3.45%(3/87).There was no statistical difference in both groups(P>0.05).Conclusion:TPTX+AT can significantly reduce the levels of PTH and ALP,improve the disorder of calcium and phosphorus metabolism and clinical manifestations such as pruritus and bone pain in SHPT patients.Comparison between group TPTX+AT(4grains 1×1×1 mm~3)and group TPTX+AT(4 grains 2×2×2 mm~3),there was no significant difference in postoperative clinical remission rate and SHPT recurrence rate,and the control level of blood ALP was similar.Since the amount of autologous parathyroid transplantation in group TPTX+AT(4 grains 1×1×1 mm~3)decreased more significantly than that in group TPTX+AT(4 grains 2×2×2 mm~3),and PTH decreased more significantly in group TPTX+AT(4 grains 1×1×1 mm~3),therefore,in the treatment of renal SHPT,it may be more suitable for TPTX+AT(4 grains 1×1×1 mm~3).