Therapeutic Evaluation Of Parathyroidectom In Patients With Secondary Hyperparathyroidism

Objective:To evaluate the short-term outcomes of patients with secondary hyperparathyroidism(SHPT)who had undergone parathyroidectom(PTX).Methods: Clinical data of 61 patients who underwent parathyroidectom in our hospital during September of 2013 and June of 2015 were reviewed retrospectively.Their serum intact parathyroid hormone(i PTH),calcium,phosphorus and alkaline phosphatase(ALP)levels in the preoperative,postoperative and follow-up periods were collected and compared.Their symptoms,postoperative complications and relapse were observed and analyzed.The predictors of early postopearative hypocalcemia after PTX were identified.Three kinds of surgical methods were compared.Results: Thirty cases underwent subtotal PTX(s PTX),22 cases underwent total PTX(t PTX)and 9 cases underwent total PTX+autotransplantation(t PTX+AT).PTX operation performed successfully in 56/61 patients(91.80%).Bone pain,itching and weakness were alleviated after PTX.Refractory hypotension were corrected in two patients.The appetite,sleep and mental status of all patients were improved compared with the preoperation.The postoperative serum i PTH(P<0.001),serum phosphorus(P<0.001),serum calcium(P<0.001)and serum ALP(P <0.001)lowered significantly than those at preoperative period.The postoperative complications such as hoarseness,dysphagia,bucking,infection of incisional wound,hemorrhea and asphyxia were no found.Postoperative hypocalcemia was frequently seen in 53/61 patients(86.89%),and it was effectively controlled by supplying calcium.No severe complications were caused by hypocalcemia.Serum calcium levels one-day post-surgery negatively correlated with preoperative i PTH(r=?0.669;P<0.001)and preoperative ALP(r=?0.385;P=0.005).Serum calcium levels one-day post-surgery were not the same between the three different surgical methods(F=5.621;P=0.006).The postopearative hypocalcemia was not associated with age,dialysis duration,preoperative serum calcium and preoperative serum phosphorus.The rates of persistent or recurrent hyperparathyroidism were 21.31%(13/61)in the follow-up period for half a year.Six patients underwent s PTX,5 patients underwent t PTX and 2 patients underwent t PTX+AT.Serum calcium levels one-day post-surgery and preoperative ALP were not the same between the three different surgical methods.But they had no significant difference in the gender composition,age,dialysis duration,postoperative hospitalization time,preoperative serum i PTH,preoperative preoperative serum calcium,serum phosphorus,operation success rate and the incidence of persistent or recurrent hyperparathyroidism.Conclusion: PTX is a safe and effective measure for the treatment of patients with chronic kidney disease and refractory SHPT.