Clinical Analysis Of Surgical Treatment Of Secondary Hyperparathyroidism

Objective:To investigate the clinical efficacy of subtotal parathyroid resection and total parathyroidectomy plus autologous transplantation on patients with secondary hyperparathyroidism,in order to provide better clinical treatment for such patients and make them more quality of survival.Methods:From June 2016 to December 2021,79 patients with SHPT who underwent parathyroidectomy treatment at The China-Japan Union Hospital of Jilin University,48 patients in the total parathyroidectomy combined with auto-transplantation group,and31 cases in the subtotal parathyroidectomy group.The safety and efficacy of TPTX+AT were judged by comparative analysis of the operation time,postoperative complications and recurrence rate of the two groups,and the preoperative and postoperative records of parathyroid hormone（PTH）,alkaline phosphatase（ALP）,calcium,phosphorus and bone density（BMD）were collected.Calculate the surgical success rate and recurrence rate.Postoperative complications（hypocalcemia,recurrent laryngeal nerve injury）are recorded.Follow-up of patients for PTH,ALP,BMD,and clinical symptoms.Compare the above parameters for the two groups.The time point of all patients followed up is1 year.Results:In 79 cases,the general data of the two groups were compared,and the proportion of primary disease was similar.The ratio of male to female,average age and dialysis duration of the two groups were statistically analyzed,P > 0.05,and the included case data were reasonable.The success rate was 100% in both groups.The operation time of SPTX group was significantly shorter than that of TPTX+AT group,and the difference was statistically significant.There was no statistical significance in the incidence of recurrent laryngeal nerve injury,hypocalcemia and the average relief time of postoperative bone pain between the two groups.Serological changes of the two groups were consistent,the blood calcium value decreased after operation,and the blood calcium value was the lowest 1 month after operation.Blood phosphorus decreased at all time points after operation.Alkaline phosphatase was the highest in 1 month after operation,then decreased significantly,and basically returned to normal level in 6 months after operation.After the operation,the parathyroid hormone decreased significantly compared with that before the operation,and rose slowly one month after the operation,still in the normal range.Preoperative BMD of the two groups were-2.69±1.47 and-2.32±1.47,respectively;BMD at 3 months after operation were-2.06±1.51 and-1.77±1.48,respectively.BMD values at 12 months after surgery were-1.40±1.44 and-0.95±1.47,respectively.BMD changes in both groups gradually approached the normal value,and the differences were statistically significant compared with those before surgery.The scores of postoperative quality of life in both groups were higher than those before surgery,and the difference was statistically significant.The survival rate of forearm muscle graft in TPTX+AT group was 93.75%.There were 2 cases of recurrence in SPTX group and 1 case of recurrence in TPTX+AT group,with recurrence rates of 12.90% and 4.17%,respectively,and the difference was statistically significant.Conclusion:1)Parathyroidectomy can effectively treat the clinical symptoms such as bone pain,fracture and skin itching in patients with secondary hyperparathyroidism caused by chronic kidney disease failure,improve serological indicators,reduce all-cause mortality of cardiovascular and cerebrovascular diseases,and greatly improve the quality of life of patients.2)Subtotal parathyroid resection surgery time is short,the incidence of severe hypocalcemia is low,but the recurrence rate is high,and the preferred surgical method for non-clinical parathyroid resection is optional for patients with kidney transplantation.3)Total parathyroid resection + autologous transplantation surgery not only solves hyperparathyroidism,but also reduces the recurrence rate;if hyperparathyroidism recurs,the parathyroid glands that cause recurrence can be removed by local anesthesia,which may be the preferred surgical method for patients with secondary hyperparathyroidism who require non-renal transplantation.