Clinical Observation On The Curative Effect Of Parathyroid Resection On Patients With Secondary Hyperparathyroidism

To investigate the efficacy of parathyroidectomy in the treatment of secondary hyperparathyroidism and to compare the advantages and disadvantages of different parathyroidectomy.MethodsTheclinical data of100casesof patients with secondary hyperparathyroidism who underwent parathyroidectomy from July 2015 to February 2018 in the Department of Gastrointestinal Glands Surgery of the First Affiliated Hospital of Guangxi Medical University and the Department of Breast and Thyroid Surgery of the First People's Hospital of Nanning City,Guangxi were collected?including the patient's name,gender,age at the time of operation,whether continuous dialysis treatment was performed and its duration,basic kidney diseases,main clinical symptoms before operation,and the improvement of the symptoms after operation,etc?.This paper collated and analyzed the changes of serum calcium(Ca²⁺),phosphorus(P³⁺)and intact parathyroid hormone?iPTH?of d₁,d₇,m₁,m₃ and M₁₂2 before and after operation,and calculated the operation methods,the success rate of the operation,the incidence of complications,and the recurrence rate after operation.Results1.40 cases of patients with secondary hyperparathyroidism in the Department of Gastrointestinal Glands Surgery of the First Affiliated Hospital of Guangxi Medical University met the criteria of inclusion in the study.Among them,23 cases?57.5%?were males and 17 cases?42.5%?were females,aged29-68?47±10.4?years,26 cases?65.0%?underwent peritoneal dialysis,14 cases?35.0%?underwent hemodialysis.The average duration of dialysis was?102±45?months.The operative method was TPTX+AT?transplantation group?.The intact parathyroid hormone level of preoperative serum was?1734.47±414.82?pg/ml.60 cases of patients with secondary hyperparathyroidism in the Department of Breast and Thyroid Surgery of the First People's Hospital of Nanning City,Guangxi met the criteria of inclusion in the study.Among them,42 cases?70.0%?were males and 18 cases?30.0%?were females,aged 27-70?46±12.4?years,37 cases?61.7%?underwent peritoneal dialysis,23 cases?38.3%?underwent hemodialysis.The average duration of dialysis was?103±47?months.The operative method was TPTX.The intact parathyroid hormone level of preoperative serum was?1782.93±536.46?pg/ml.2.All the patients included in this study had various clinical symptoms such as bone pain,weakness,skin itching and so on.Most of the patients'main clinical symptoms could be improved after operation.Compared with pre-operation,the indexes(Ca²⁺?P³⁺?iPTH)of transplantation group and non-transplantation group decreased significantly?P<0.05?in the first day,the first week,the first month,the third month and the first year after operation;Compared the serum Ca²⁺levels in transplantation group at different time points with those of the non-transplantation group at the same time points,the part of the differences were statistically significant?P<0.05?.Compared the serum P³⁺and iPTH levels in transplantation group at different time points with those of the non-transplantation group at the same time points,there was no significant difference?P>0.05?.3.Compared with pre-operation,the level of serum iPTH decreased by more than 50%on the first day after operation,and the operation was considered successful.38 cases were successful in the transplantation group,and 57 cases were successful in the non-transplantation group.The success rate of operation in both groups was 95.0%.There was 1 case?2.5%?recurrence in transplantation group and 3 cases?5.0%?recurrence in non-transplantation group,and there was no significant difference in recurrence rate between the two groups?P>0.05?.Hypocalcemia occurred in 95 patients after operation,including 39 cases?97.5%?in transplantation group and 56 cases?93.3%?in non-transplantation group.Tetany occurred in 4 patients after operation,including 1 case in transplantation group and 3 cases in non-transplantation group.Hoarseness and cough?while drinking water?occurred in 3 patients after operation,including 2 cases in transplantation group and 1 case in non-transplantation group.No one died in the perioperative period.ConclusionBoth TPTX and TPTX+AT can significantly reduce the serum levels of Ca²⁺,P³⁺,and iPTH level in patients with secondary hyperparathyroidism of chronic kidney disease and alleviate their clinical symptoms.Both treatments can achieve good clinical efficacy.TPTX+AT is more advantageous in correcting serum calcium metabolic disorders in patients with secondary hyperparathyroidism,which has lower short-term recurrence rate.