Analysis Of Clinical Features Of 101 Patients With Hyperparathyroidism Postoperative

Objective:The study retrospectively analyzed the clinical data of 101 patients with hyperparathyroidism who underwent parathyroidectomy surgery in Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2012 to August 2018,which may deepen our cognition of hyperparathyroidism clinical features and improve the clinical diagnosis.Methods:This study retrospectively summarized and analyzed the clinical data of101 patients with hyperparathyroidism who underwent parathyroidectomy surgery in Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2012 to August 2018.In the patients,31 were males and 70 were females,aged from 15 to 82 years old.Their clinical manifestations,laboratory tests,imaging examination,postoperative pathological type and surgical treatment effect were analyzed.Results:101 hyperparathyroidism patients were chosen,among which 94 patients manifested with hypercalcemia,including 22 cases of neck mass,15 cases of asymptomatic,12 cases of urinary calculus,9 cases of fatigue,7 cases of joint pain and so on.The preoperative blood calcium level was?3.09±0.49?mmol/L and 12 of them presented with hypercalcemic crisis,the preoperative PTH level was?682.47±785.23?pg/mL.The blood calcium level was?2.29±0.30?mmol/L,among which 40patients with hypocalcemia,the PTH level was?42.27±120.38?pg/mL on the first day after surgery.The clinical manifestations of 7 patients with normocalcemic primary hyperparathyroidism including vomiting,neck mass,facial convulsion,neck pain,and 3 cases of asymptomatic.The preoperative blood calcium level was?2.41±0.07?mmol/L and the preoperative PTH level was?98.39±17.40?pg/mL.The blood calcium level was?2.20±0.20?mmol/L and there were 3 patients with hypocalcemia,the PTH level was?20.25±9.76?pg/mL on the first day after surgery.The preoperative alkaline phosphatase level in 101 patients with hyperparathyroidism was?288.89±749.37?IU/L.Correlation analysis showed that there was a positive correlation between serum calcium levels and alkaline phosphatase levels in these patients?r=0.246,P<0.05?.The preoperative creatinine level in 6 chronic kidney insufficiency patients with tertiary hyperparathyroidism was?861.83±238.31??mol/L.All patients underwent Doppler ultrasound,the positive rate was 65.3%.Among them,87 patients underwent ^99mT_c-MIBI Parathyroid imaging,the positive rate was 95.4%.31 patients underwent cervical CT scan,and the positive rate was 51.6%,among which,2 patients were diagnosed with ectopic parathyroid adenoma;Parathyroid cystic puncture were performed in 3 patients with hyperparathyroidism,and the PTH level of 2 patients were significantly increased in cystic fluid;1 case was considered as parathyroid cyst,1 case was considered as Parathyroid adenoma with cystic degeneration,and 1 case was considered as parathyroid adenoma,whose PTH was normal in cystic fluid.101 patients with hyperparathyroidism underwent parathyroidectomy.The pathological results showed that 97 cases with hyperparathyroidism were parathyroid adenoma?96%?,3 cases were parathyroid carcinoma?3%?,1 case was parathyroid cyst?1%?.36 cases were considered with thyroid disease whounderwent thyroid surgery in the patients,accounting for 35.6%,among which,18 cases were thyroid papillary carcinoma or thyroid papillary microcarcinoma,17 cases were goiter and 1 case was follicular adenoma.39 patients underwent immunohistochemistry,including 39 patients with PTH positive,24patients with CgA positive,9 patients with PCK positive and 7 patients with Syn positive.Among patients with thyroid carcinoma,6 cases was Braf positive.36 patients attended post-surgery appointment,including 9 patients had high PTH,among which,6 cases with tertiary hyperparathyroidism and 3 cases with parathyroid carcinoma.Conclusion:1.The etiology of hyperparathyroidism include parathyroid adenoma,parathyroid carcinoma and so on.Hyperparathyroidism can insult several organs,including skeleton,kidney,gastrointestinal tract,cardiovascular.Some patients have no obvious clinical symptoms and only be manifested with blood calcium elevated.Some patients also manifested with normocalcemic hyperparathyroidism.2.Detectation of serum parathyroid hormone and serum calcium is the main laboratory test for hyperparathyroidism.The localization diagnosis methods for hyperparathyroidism mainly include cervical Doppler ultrasound,cervical CT scan and ^99mT_c-MIBI parathyroid imaging.Doppler ultrasound is the most economical medical examination.Parathyroid imaging has the highest positive rate.3.Surgery is the preferred method for hyperparathyroidism treatment.Patients with parathyroid carcinoma and tertiary hyperparathyroidism are prone to recurrence,which need to be followed-up closely.4.Hyperparathyroidism patient can combine with thyroid carcinoma.Preoperative localization diagnosis of parathyroid lesions and evaluating the thyroid lesions will help us to choose the most proper surgery therapeutic way.Meanwhile,we need to pay attention to the exploration of thyroid lesions during surgery,which may help us avoid unnecessary secondary surgery and achieve better therapeutic effect.