| Objective:To retrospectively ananlyze the efficacy between total parathyroidectomy(TPTX)and total parathyroidectomy combined with anterior cervical sternocleidomastoid muscle transplantation(TPTX-AT)in the treatment of uremic secondary hyperparathyroidism,and to explore and analyze the risk factors of postoperative recurrence of uremic secondary hyperparathyroidis(SHPT).Medthods:The clinical data of 138 patients with uremia secondary hyperparathyroidism admitted to the Department of Thyroid Surgery,Second Affiliated Hospital of Nanchang University from February 2016 to February 2018 were collected,124 eligible cases were screened by inclusion and exclusion criteria.The patients were divided into two groups according to different surgical methods(TPTX group,TPTX-AT group),including 54 patients in the TPTX group and 70 patients in the TPTX-AT group.The parathyroid hormone,serum calcium,blood phosphorus,creatinine,alkaline phosphatase and other blood indicators and related clinical symptoms change data were collected before and after surgery.Compare the difference of the surgical success rate,postoperative basic clinical symptoms,postoperative recurrence rate,postoperative complications,operation time,hospitalization between the two groups of surgical methods.Results:The success rate of TPTX-AT was 66/70(94.3%),and the success rate of TPTX group was 52/54(96.3%).Respectively,each have 4,2 patients were still characterized by persistent SHPT after operation.There was no significant difference between the success rate of the two groups(P=0.924>0.05).The parathyroid hormone,serum calcium,serum phosphorus,alkaline and phosphatase was significantly decreased in 1 day,3 days,1 month,3 months,6 months and 1 year after TPTX-AT and TPTX group(P<0.05).The serum parathyroid hormone was significantly lower in the TPTX group than in the TPTX-AT group at 1 day,3 days,1 month,3 months,6 months,and 1 year(P< 0.05).The blood calcium index of the TPTX group was significantly lower than that of the TPTX-AT group at 1 day,3 days,1 month,3 months,and 1 year(P<0.05),but there was no significant in blood calcium level after 6 months.There was no significant difference in postoperative serum phosphorus levels between the two groups(P>0.05).The levels of alkaline phosphatase in the TPTX-AT group were significantly lower than that of TPTX group in 1 month,3 months,6 months and 1 year after surgery(P<0.05).The clinical symptoms of postoperative patients such as bone pain,short stature,itchy skin,fractures,etc were significantly improved compared with preoperative,but there was no significant difference between the groups.There was no statistical difference in academic significance(P>0.05).TPTX-AT group required longer operation time than TPTX group,and TPTX-AT group required shorter hospital stay than TPTX group,there were significant differences between the two groups(P<0.05),but there was no significant difference in the number of parathyroid glands removed during surgery and postoperative complications such as postoperative hemorrhage,persistent SHPT,temporary or permanent recurrent laryngeal nerve palsy(P>0.05),Postoperative recurrence occurred in 1 case(1/54)in the TPTX-AT group and 4 cases(4/70)in the TPTX group and there was no significant difference between them(P=0.533).Conclusions:Both TPTX-AT and TPTX can effectively treat uremiasecondary hyperparathyroidism,but the long-term hypoparathyroidism caused by TPTX surgery leads to long-term low hypocalcemia in the study within 3 months,and there was no significantly different in the rate of intraoperative and postoperative complications,and recurrence between the two procedures.It can be seen that the TPTX-AT procedure does not increase the rate of intraoperative and postoperative complications and recurrence.It is more effective to ensure the patient's postoperative quality of life,thus showing the unique superiority of the TPTX-AT procedure. |
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