| Objective Hypertension is one common complication of end-stage renal disease, which often leads to cardiovascular system complications, and affects life quality. In some cases, even treatments including adequate dialysis or taking oral antihypertensive drugs are ineffective to maintain a normal blood pressure. Large number of studies, including both domestic or international cases, have shown that high parathyroid hormone level is related to high blood pressure. The objective of current study is to study the effect of total parathyroiectomy with autotransplantation(PTX+AT) on the blood pressure of renal secondary hyperparathyroidism(SHPT) patients.Method(1) Cases chosen: 41 patients with renal SHPT were chosen from our hospital form February 2011 to March 2013, including 27 men and 14 women. 35 patients accepted hemodialysis and 6 patients accepted abdominal dialysis in the past. The average period of dialysis was 7.8 years. Among those 41 patients, 35 were complicated with preoperative hypertension.(2) Research methods: Patients were detected with changes in their preoperative and postoperative parathyroid hormone(i PTH), blood calcium and blood phosphorus. Blood pressure of each patients was measured during preoperative and postoperative outpatient visits. After 15 minutes rest, brachial artery blood pressure on the non-internal fistula side of each patient in sitting position was measured with a vertical mercury sphygmomanometer for three times, and an average value was recorded(Peritoneal dialysis patients were measured on the right side). The blood pressure of each patient was measured and recorded by the same doctor during pre-arranged visits. All patients maintained the original dialysis regimen and paid return visits for more than 3 months.(3) Curative effect measurements: "Notably Effective" : the systolic blood pressure dropped > 20 mm Hg, or diastolic blood pressure dropped > 10 mm Hg and down to normal while decreasing or stopping antihypertensive drugs, and maintaining the preoperative antihypertensive drugs. Effective: under the condition of maintaining the preoperative blood pressure medication regimen, diastolic pressure dropped < 10 mm Hg or systolic blood pressure droped 10-19 mm Hg. Ineffective: the drop in blood pressure did not reach the standard defined in "Effective", or even raised comparing to the preoperative value; or an increase of dosage or change of types of antihypertensive drugs is needed. If the frequency of postoperative hypotension off dialysis day or hypotension in the process of hemodialysis reaches > 3 times/2 weeks.The total effective number combined markedly effective number and effective number togetherResult:(1) 41 cases went through surgeries successfully. In 35 cases, the four parathyroid glands were resected completely. In 5 cases, only 3 parathyroid glands were discovered and removed. And in 1 case, 2 parathyroid glands were found and removed.(2) Bone pain, itching and restless leg symptoms were significantly alleviated 2 days after surgery in all cases. Poor appetite and anemia symptoms were also significantly alleviated within 1 month after the day of surgery. The height of patients with Shrinking Man Syndrome stopped further decrease 3 months after surgery. Except for 2 cases of surgical failures, bone pain, itching and restless legs symptoms did not relapse in the other 39 patients postoperatively within 3 months.(3) Blood calcium, blood phosphorus and i PTH of patients in the 39 successful operations(33 patients with hypertension and 6 patients without hypertension) were significantly decreased comparing with preoperative values(P < 0.05) in 2 weeks or 12 weeks after surgery.(4) Two out of six patients without high blood pressure history appeared postoperative hypotension. Postoperative blood pressure monitoring of the 33 hypertension cases after successful operation suggested: 20 cases were markedly improved(61%), 8 cases were improved(24%) and 2 cases were invalid(6%), 3 patients showed postoperative hypotension(9%). The total effective rate was 85%. Blood pressure data of 35 patients was statistically analyzed with paired T-test, and p-values was set as 0.01.Conclusion:(1) "Total parathyroiectomy and autotransplantation" is a safe and effective treatment method of renal hyperparathyroidism, with definite curative effects and a lower cost.(2) For the renal hyperparathyroidism patients complicated with preoperative hypertension, the treatment can significantly help the control of hypertension.(3) A few patients may encounter dialysis hypotension postoperatively. An appropriate assessment of dry weight, the adjustment of the ultrafiltration modes and drug treatments can help patients to complete daily dialysis. |
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