Comparative Analysis Of Clinical Efficacy In The Treatment Of Primary Hyperparathyroidism Of Ultrasound-guided Thermal Ablation And The Open Surgery

Objective :To explore the clinical efficacy and comparative study of ultrasound-guided percutaneous thermal ablation and open surgery for primary hyperparathyroidism.Method:Follow-up data of 23 cases of primary hyperthyroidism treated in the China-Japanese Union Hospital of Jilin University Thyroid Surgery were collected,from February 2012 to December 2014.Among the 23 cases,13 were treated by open surgery,while the others were treated by ultrasound-guided thermal ablation.In all cases,the neck ultrasonography revealed the hypoechoic nodules of the thyroid dorsal or lower extremities,and the boundary was clear.The parathyroid SPECT/CT fusion imaging of 8 cases treated by thermal ablation and 9 cases treated by open surgery suggested a slightly lower density associated with increased radiation distribution,and considered the possibility of hyperfunctioning parathyroid glands.Preoperative parathyroid hormone(PTH)and serum calcium were detected,and all results were raised.All patients underwent PTH test at 15 min and 30 min after surgery.Patients,before discharged,1 month,3 month,6 month and 12 month after surgery,detected with PTH and serum calcium.Results:The two groups both had a smooth operation.In the ablation group,operation of one case succeeded at the second ablation,others succeeded at the first ablation.After 6 months,12 months,and 24 months,the rate of disappearance of ablation area was 12.5%,50% and 62.5%,respectively.Ablation group showed postoperative hypocalcemia in 1 case and recurrence in 2 cases.In the operation group,2 cases of hypocalcemia and 1 case of recurrence occurred postoperatively.Compared with the preoperative,two groups of postoperative serum parathyroid hormone and the result of serum calcium were significantly lower(P < 0.05),compared two groups of 24 months postoperative serum PTH and serum calcium test results,no statistical difference(P > 0.05).The mean hospital stay of ablation group was significantly lower than that of operation group(P < 0.05).The recurrence rate of ablation group was slightly higher than that of surgery group,but there was no statistically significant difference between the two groups in terms of complications and recurrence rate(P > 0.05).Conclusion:Thermal ablation for primary hyperparathyroidism is effective.Compared with open surgery,it has the advantages of short hospitalization time,small trauma,simple operation and repeatable operation,and is a safe,minimally invasive and effective treatment method.However,the indications should be strictly controlled,and the factors such as the patient's whole body state and local conditions should be comprehensively analyzed.