The Study Of Perioperative Management Of Secondary Hyperparathyroidism On Long-Term Hemodialysis

Objective:By retrieving the literature systematically,this study initially developed a clinical pathway on SHPT.It was applied in clinical practice.Through multiple disciplinary team working together and strengthening the management of perioperative patients,reduce the medical costs,improve the success rate of surgery,reduce the incidence of complications and improve clinical outcomes..Methods: Searching articles wrote in English about SHPT published in PubMed,Embase and Cochrane database.We removed the review,case report,editorial and duplicate publication.In this way,we conducted a literature study on surgical treatment of SHPT.Searching articles wrote in English about SHPT published in Pub Med database,from inception to December 30,2016.We combined Medical Subject Headings(Me SH)with subheading together to search studies.And some studies were searched by manual retrieval.The retrieved studies were classified into Randomized Clinical Trials(RCTs),cohort studies and case-control studies.The American College of Physicians(ACP)grading system was used to give the level of evidence,and from the perspective of patients and doctors to give a recommendation.From July 2014 to February 2017,24 patients were treated surgically at the Affiliated Hospital of Qingdao University and the clinical data were analyzed retrospectively.2 patients underwent total parathyroidectomy(t PTX),and 22 patients underwent total parathyroidectomy with autotransplantation(t PTX+AT).Laboratory data(serum calcium,serum phosphorus and intact parathyroid hormone)during the perioperative period were assessed.We also analyzed the improvement of clinical symptoms and pathological results.Results:Finally,43 studies were included in this analysis,published from 1980 to 2016.The number of patients ranged from 10 to 898.The number of published studies increased with time.Perioperative management of SHPT included the diagnosis of disease,surgical indications,preoperative positioning,preoperative preparation,surgical types,auxiliary procedures during surgery and postoperative management.Our study was conducted from these aspects.The diagnosis of disease was mainly based on medical history,laboratory tests and clinical manifestations.The laboratory tests were mainly based on serum calcium,phosphorus and i PTH.The more commonly used preoperative positioning techniques included high-resolution ultrasound,99 m Tc-MIBI and CT.The high-resolution ultrasound was the preferred method of examination(moderate-quality evidence;strong recommendation).Among them,high-resolution ultrasound combined with 99 m Tc-MIBI were the main preoperative positioning method(moderate-quality evidence;strong recommendation).The rest was described in the text section.There were 10 male patients and 14 female patients.The average age of the patients was 45.79±8.62 years old,ranging from 28 years old to 64 years old.The average dialysis age was 7.14±2.64 years,ranging from 1.5 years to 15 years.The total success rate was 90.00% in 20 patients after 1 month.One weak after surgery,the remission rate of bone pain and skin itching was 92.86% and100.00%,respectively.The incidence of postoperative hypocalcemia was 95.83%.A total of 90 parathyroid glands were removed,of which 47 were nodular hyperplasia glands,accounting for 52.22% of the total removed glands,while the rest were parathyroid adenoma,accounting for 47.78%.Conclusions:By searching and analysing literature,we classified the evidence and established a clinical pathway about perioperative management of SHPT on long-term hemodialysis.The application confirmed that the pathway can be effectively used in patients with perioperative management and improve the clinical outcome.