Effect Of Parathyroidectomy On Uremic Secondary Hyperparathyroidism

Background:Secondary hyperparathyroidism?SHPT?is a commom complication of chr onic kidney disease?CKD?.Calcium and phosphorus disorder,1,25?OH?2D 3 resista nce are the main factors of SHPT.The commom symptoms are bone pain,skin itch and calcification of subcutaneous soft tissue.Furthermore,as SHPT increas es the incidence of cardio-cerebrovascular events,life quality of uremic patients is seriously threatened.Correct the calcium and phosphorus metabolism disorder at the early stage is the key treatment.As the progression of SHPT,parathyroid glands turn to adenomatously hyperplasia with parathyroid hormone?PTH?indep endence,and expression of vitaminD,calcium sensitive receptor?CaSR?is signifi cantly reduced,which lead to the less respond of calcium,phosphate binders and VitD treatment,called refractory hyperparathyroidism.Parathyroidectomy?PTX?is an effective mean of SHPT,hither to there are three different operations,subot al parathyroidectomy(S-PTX,total parathyroidectomy?T-PTX?,parathyroidectomy combined with autotransplantation?PTX+AT?.AS they all have benefits and disadvantages,no clinical research give final conclusion on the curative effect,c omplications,recurrence rate of different operations.Study on this will be in fav oue of operation choice.Object:To investigate the clinical effects,complications,recurrence rate of S-PTX,T-PTX,and PTX+AT on SHPT in uremic patients.Method:A total of 72 SHPT patients treated with S-PTX,T-PTX,or PTX+AT in our hospital during the period April 2014 to October 2016 were retrospectively analyzed,forty in S-PTX group,sixteen in T-PTX group and sixteen in PTX+AT group.The changes of intact parathyroid hormone?i PTH?,serum phosphorus?P?,serum calcium?Ca?,bone pain and skin itch,postoperative complications,recurrence rate in these patients were studied after the operations.Normal or ne ar normal distribution of measurements were described as???,the two samp les before and after operation in each group were compared using paired t-test;comparations among threedifferent groups were made with one-way ANOVA first,LSD-t test was then used in those two have statistical significances;Skewed distribution of measurement data were described as Me?P25,P75?,comparation s insideeach group were using Wilcoxon test,and comparations among three different groups were first made with Kruskal wallis test,Mann-Whitney testwas then used in those two have statistical significances.The count datawere descr ibed as case number?percent?and conducted chi-square test.P<0.05 was statisti cally significant,P<0.01 significant statistical significance.Results:1.Surgical operations were successfully performed in 71 patients.Bone pain,skinitch,and calcification of subcutaneous soft tissue were alleviated with different degrees,with the most effectiveness on bone pain.T-PTX was the most effective modality for relief of SHPT symptoms.2.Serum Ca,P and iPTH reduced significantly after the operation for one week,one month and 6 months in all patients as compared with those before the operation?P<0.05?.3.Serum Ca²⁺ and P after the operation for one week,one month and 6 m onths had no statistical significances among the 3 groups?P>0.05?.Serum i P TH levels had no differences between PTX+AT group and S-PTX group?P>0.05?,both of them were statistically higher than in T-PTX group?P<0.05?.4.There were no statistical differences among the 3 PTX methods in succ essful rate?P>0.05?;cure rate in PTX+AT group and T-PTX group were stat istically higher than in S-PTX group?P<0.05?;incidence rate of voice hoarse complication,prevalence of hypocalcemia in one week after the operation,relaps e rate in six months after the operation had no statistical significances among the 3 groups?P>0.05?.Conclusions:1?The operations of T-PTX,S-PTX and PTX+AT are safe and can all tre at uremia SHPT effectively.T-PTX was the most effective modality for relief of SHPT sympotoms.Cure rate were higher in T-PTX and PTX+AT group com pared with S-PTX group.The reduction of serum Ca and P showed no differen ce among the 3 groups,but the reduction of iPTH was most effectively in T-P TX group.Incidence rate of voice hoarse complication,relapse rate in six mont hs after the operation had no statistical significances among the 3 operations.2?As serum i PTH levels were higher after the operation for one week,on e month and six month in PTX+AT group and S-PTX group than T-PTX grou p,relapse rate may be higher in PTX+AT group and S-PTX group after 6 mont h.so if patients have no willing to kindney transplantion,we recommend T-PTX,which can alleviate symptom safely and effectively,and reduce the second operation.