The Therapeutic Evaluation Of Surgical Procedure In Treatment Of Secondary Hyperparathyroidism

Objective: To analyze the short-term and long-term outcomes of the three operation methods in treatment of secondary hyperparathyroidism.Methods : Clinical data of 88 patients who underwent parathyroidectomy for secondary hyperparathyroidism from October 2004 to October 2014 were reviewed retrospectively. Patients were divided into three subgroups, including subtotal parathyroidectomy(group I), total parathyroidectomy with autotransplantation(group II) and intraoperative,99mTc—MIBI radioguided total parathyroidectomy with autotransplantation(group III).Their serum calcium, phosphorus, serum iPTH results in the preoperative, postoperative short-term(?6 months) and long term(>6 months) were collected and compared. The improvements of clinical symptoms together with the postoperative recurrence rate and the complication data were observed and analyzed.Results : The symptoms of all patients improved after the operation?The short-term postoperative serum calcium, serum iPTH and recurrence rate of Group I and group II are not statistically significant. The short-term postoperative serum calcium, iPTH and recurrence rate were significantly lower than that of group I and group II(P<0.05). Three groups of postoperative serum phosphorus values had no statistical difference. The operation time of group III is significantly shorter than that of group II, the difference was statistically significant(P<0.05). Pathology confirmed that parathyroid glands were more accurately identified in group III than in group II(P<0.05). For the Long term follow-up, the postoperative serum calcium, phosphorus, serum iPTH and recurrence rate of group I and group II are notstatistically different. The postoperative recurrence rate of group III are lower than that of group I and group II(P<0.05).Conclusion : Total parathyroidectomy with autotransplantation has a good efficacy to treat secondary hyperparathyroidism.The intraoperative 99mTc—MIBI radioguided total parathyroidectomy with autotransplantation can find the ectopic and supernumerary glands to improve the success rate of operation. And it also can permit omission of frozen section to reduce the operative time.In the postoperative follow-up, the recurrence rate is low, so it is a safe andeffective treatment.