| Objective:To investigate the clinical significance of parathyroidectomy(PTX)in patients with secondary hyperparathyroidism(SHPT).Meathords:A retrospective study was conducted for patients with SHPT undergoing parathyroidectomy in the Second Affiliated Hospital of Dalian Medical University in the urology department from March 2013 to January 2016.Clinical datas of 47 cases were collected.Operation method can be either t PTX or t PTX+AT.The data regarding age,gender,dialysis duration,operation method,the resected parathyroid gland number(RTPN),pathological findings of the surgical samples,calcium requirements in a week and recurrence rate were collected.The serum intact parathyroid hormone(iPTH),serum alkaline phosphatase(ALP),serum calcium and phosphorus were measured preoperatively and 1 day,1 week,1 month,3 months,6 months,1 year postoperativly.The remission of bone pain,pruritus and restless legs syndrome were acknowledged.Analysis of the related factors of preoperative PTH level and calcium requirements within a week was carried out.After through the analysis,we established calcium supplement within a week by the multivariate stepwise regression equation.We also compared the effects between t PTX and t PTX+AT.Results:In the 47 PTX cases,37 cases(78.7%)were treated with t PTX,and 10 cases(21.3%)were subjected to t PTX+AT.The proportion of bone pain,pruritus,restless legssyndrome,and ectopic calcification proportion was 93.6%?44.7%?19.1%?80.8% respectively.PTX operation was performed successfully in 45 patients(95.7%),there was no cases of death and no cases of wound bleeding,infection,and serious wound hematoma in the perioperative period.Injury of recurrent laryngeal nerve was found in 4 cases.Vital signs were stable among all the patients in the postoperative period,the patients were discharged from hospital about 1 week.In the hospital,46 patients(97.9%)required oral or intravenous calcium supplement within a week postoperativly.On average 3 ~ 6 parathyroid gland were resected,there were 8 cases of thyroid cancer.The pathological features in the resected parathyroid gland were diffuse proliferation in 3 patients,nodular changes in 2 cases,and parathyroid adenoma of parathyroid gland in 42 patients,some samples also accompanied with calcification,bleeding or cystic degeneration.Among 47 cases mean age was 50.3±15.2years,and the dialysis duration ranged 6.7±3.4 years.Serum iPTH(P<0.05),phosphorus(P<0.05)and calcium(P<0.05)were lower than those in preoperative period.There were no obvious changes among ALP(P>0.05)1 week postoperativly.During the follow-up,the remission of relieved patients with bone pain,pruritus,restless legs syndrome was92%,94%,97% respectively.Only 1 case with recurrent laryngeal nerve didn't recover and 5cases unfortunately died.Recurrent hyperparathyroidism was found in 6 cases and 1 case was diagnosed as graft-dependent recurrence and was cured by removal of the graft.Preoperative PTH level was positively correlated with preoperative ALP(r=0.778,p=0.000).Calcium requirement within a week postoperativly was positively correlated with preoperative PTH(r=0.306,p=0.037)and preoperative ALP(r=0.311,p=0.033).The hypocalcemia rate,recurrence rate,serum iPTH,serum phosphorus and serum calcium 1 month postoperativly had no significant difference(P>0.05)in the two types of operation.Conclusion:1.PTX can correct the biochemical indicators and alleviate clinical symptoms,for example,bone pain,pruritus,restless legs syndrome.2.Preoperative PTH level was positively correlated with preoperative ALP(r=0.778,p=0.000).Calcium requirement within a week postoperativly was positively correlated with preoperative iPTH(r=0.306,p=0.037)and preoperative ALP(r=0.311,p=0.033).3.The hypocalcemia rate,recurrence rate,serum iPTH,serum phosphorus and serum calcium within 1 month postoperativly had no significant difference(P>0.05)in the two types of operation. |
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