| Objective:To compare the clinical efficacy of subtotal parathyroidectomy(SPTX),total parathyroidectomy(TPTX)and total parathyroidectomy plus autograft(TPTX+AT)for the treatment of secondary hyperparathyroidism caused by chronic renal failure and their respective advantages and disadvantages,and to investigate the current optimal surgical plan for the treatment of secondary hyperparathyroidism.Methods:1.The clinical data of 72 patients with SPTX and 35 patients with TPTX admitted to our hospital from October 2008 to December 2014 were retrospectively analyzed.The i PTH and serum calcium and blood phosphorus levels were measured at preoperative,intraoperative and postoperative day 1,week 1 and month 6,respectively.The changes of symptoms such as itching and bone pain before and after surgery,as well as changes in quality of life and renal hypertension were compared.The advantages and disadvantages of each of the two surgical methods were revealed.2.By comparing the advantages and disadvantages of the above two surgical methods,a prospective controlled study was designed to analyze the clinical data of 110 patients with hyperparathyroidism after uremia admitted to our hospital from June 2015 to December 2016.The total parathyroid hormone and serum calcium and blood phosphorus levels of the patients on preoperative and postoperative day 1,week 1,month 6 and year 1 were analyzed.The efficacy and recurrence rate through TPTX(54cases)and SPTX(56 cases)were compared.3.To analyze the clinical data of 29 patients with secondary hyperparathyroidism who underwent total parathyroidectomy plus forearm subcutaneous autograft in our hospital from June 2016 to September 2018.The total parathyroid hormone,serum calcium and blood phosphorus levels of the patients tested on the preoperative and postoperative day 1,1 week,6 month,12-24 months 1 week,6 months,and 12-24 months were observed.The curative effect,recurrence,and treatment strategies during recurrence were observed.Results:1.Of the 72 patients in the SPTX group,70 had successful operation,and the success rate was 97.2%.Most patients could improve skin mucosal itching,bone and joint pain.One patient relapsed after 6 months of follow-up,1 case recurred from June to December,3 cases relapsed from12 to 24 months,and 1 case relapsed after 24 months.The total recurrence rate was 8.3%,of which 5 patients had relapsed and had received surgical treatment.35 patients in the TPTX group were successfully operated.The clinical symptoms such as skin itching,joint pain and fatigue were improved.There was no recurrence after at least 24 months of follow-up.2.Among the 110 patients,98 had successful operation and another 12 had insufficient excision.102 patients with postoperative joint pain were all relieved,and skin itching decreased in 60 cases.Both surgical methods can effectively alleviate symptoms such as skin mucosal itching,bone and joint pain.The serum calcium concentration of TPTX operation group was lower than that of SPTX operation group in the first day,seventh day and half year(P < 0.05),and the degree of i PTH in the half year after operation was significantly lower than that of SPTX operation group(P <0.05);The recurrence rate of the two groups was followed up for 6-18 months.The TPTX group was 3.92%,and the SPTX group was 10.63%.The difference was statistically significant.3.29 patients with secondary parathyroid function received total parathyroidectomy + forearm subcutaneous autologous transplantation successfully,which can effectively alleviate skin mucosal itching,bone and joint pain.Four patients had recurrence after 12-24 months of follow-up,and the recurrence rate was 13.7%.One patient underwent simple reoperation and recovered well after surgery.Conclusion:1.TPTX and SPTX can achieve satisfactory results in the surgical treatment of secondary parathyroid function,and can effectively alleviate the clinical symptoms of most patients postoperatively.2.SPTX has the advantages of small trauma,short operation time,and less hypocalcemia after surgery,but the recurrence rate is slightly higher.If the recurrence occurs postoperatively,the difficulty of reoperation is very large.TPTX has the advantages of short operation time,minimal trauma,low complication rate and low recurrence rate,but it still fails to solve the problem that the risk of the TPTX group to cause long-term hypocalcemia and refractory osteomalacia.3.Although TPTX+AT has a higher recurrence rate postoperatively,this surgical method can avoid reoperation of the neck.Meanwhile,it can not only avoid the risk of long-term hypocalcemia and refractory osteomalacia,but also reduce the incidence of cardiovascular events,considering the possibility of simple and easy reoperation.It may be the best surgical method for secondary hyperparathyroidism. |
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