Clinical Analysis Of Total Parathyroidectomy For Maintenance Hemodialysis Patients With Severe Secondary Hyperparathyroidism

Research background and objective：Secondary hyperparathyroidism (SHPT) is common in patients with chronicrenal failure. Despite the initiation of new therapeutic agents, several patients willrequire parathyroidectomy (PTX). Total PTX with autotransplantation of parathyroidtissue (tPTX+AT) and subtotal parathyroidectomy (sPTX) are currently considered asstandard surgical procedures in the treatment of sHPT.Recurrence rates after tPTX+AT or sPTX are between10%and12%(median follow up:36months). However,recent retrospective studies demonstrated a lower rate of recurrent sHPT of0–4%after PTX without autotransplantation and thymectomy (tPTX)with no highermorbidity when compared to the standard procedures.In this study,we retrospectivelyanalyze the clinical feature and the long-term prognosis ofmaintenance hemodialysis(MHD) patients with secondary hyperparathyroidism submitted to totalparathyroidectomy（tPTX）Method：A total of28MHD patients with SHPT who were treated with tPTX during the period from January，2009to December，2011were collected.Their average age was(50.1±11.0) years old,and their dialysis age range (140.1±49.7) months.Laboratorydata (intact parathyroid hormone [iPTH], total calcium, and alkaline phosphatase)assessed before, shortly postoperatively and then at a later time point.Symptomsbefore and after operation，operation complications，pathological findings of thesurgical samples，recurrence of SHPT and prognosis were analyzed.Results：Bone pain、 muscle weakness and itching were obviously improved aftertPTX.One patient had the early operation complication of transient.23cases(82.1%)had the hypocalcemia which is one of postoperation complications,but serum calciumof those returned to normal level after intravenous or oral calcium supplements.Allparathyroid pathological findings showed nodular hyperplasia. Parathyroid diffusedproliferation was found in5cases (17.8%), parathyroid adenoma in4subjects (14.2%)and parathyroid glandular cancer in2patients(7.1%). Compared with those atpreoperative period, the postoperative serum calcium（p<0.01），serum phosphorus（p<0.01）and iPTH（p<0.01）decreased significantly.After a follow-up of2years,28subjects were evaluated: three(10.7%) had persistent and one (3.5%) recurrentdisease.After3years of the operation,24patients were successfully followed and2(8.3%) of them had recurrent SHPT. iPTH decreased from a mean of (2063.00±616.37) pg/ml to (88.02±118.90)pg/ml (p<0.01). No subsequent bone fractures,persistent bone pain or disability were reported.Conclusion：tPTX should be considered a safe and successful procedure for the treatment ofsevere secondary hyperparathyroidism associated with chronic kidney disease.