Explorations And Innovations Of Surgical Treatment For Secondary Hyperparathyroidism

ObjectiveTo explore the long-term outcome of PPTX in the treatment of patients with SHPT and to assess whether carbon nanoparticle injection is useful in localizing parathyroid glands during TPTX.MethodsPart 1 Long-term outcome of purge parathyroidectomy in treatment of secondary hyperparathyroidismA total of 29 patients with refractory SHPT who underwent PPTX from June 2016 to December 2017 were retrospectively analyzed.Perioperative i PTH,calcium and phosphorus in serum were collected,and the changes of each indicator and the perioperative complications were analyzed.Serum i PTH,calcium and phosphorus were collected at 6 months postoperatively and at the last follow-up.The long-term changes of each indicator,the symptom relief,the recurrence rate,and the incidence of persistent hypoparathyroidism were analyzed.Part 2 Application of carbon nanoparticles in localization of parathyroid glands during total parathyroidectomy for secondary hyperparathyroidismA total of 61 patients with SHPT who underwent TPTX from September 2015 to November 2017 were retrospectively analyzed;of these,32 with carbon nanoparticle injection(TPTX+CN group)and 29 without injection(TPTX group).Operative duration and serum i PTH on 1 day and 1 year postoperatively were collected.Compare the difference of the surgical outcome and postoperative complications between the two groups.Subgroup analysis according to the different numbers of normal sized parathyroid glands were performed and compare the difference of operative duration and serum i PTH on 1 day and 1 year postoperatively between the two groups.ResultsPart 1 Long-term outcome of purge parathyroidectomy in treatment of secondary hyperparathyroidismOf 29 patients,5 parathyroid glands were resected in 1 patient and 4 in 28 patients.Serum i PTH,calcium,and phosphorus were significantly reduced at postoperatively day 1.During the perioperative period,27(93.10%)patients occurred different degrees of hypocalcemia.Serum i PTH,calcium,and phosphorus were also significantly lower at 6 months postoperatively and at the last follow-up compared with those preoperatively(P <0.0001).At the last follow-up,1 patient still had bone pain,and the rest of patients with bone pain,muscle weakness,and itching were significantly alleviated in several months postoperatively.1 patient had recurrence at 18 months postoperatively.At the last follow-up,10(34.48%)patients had persistent hypoparathyroidism and 20(68.97%)patients had hypocalcemia,of which,16 patients with mild hypocalcemia and 4 with moderate hypocalcemia.None of the patients occurred severe hypocalcemia with adequate calcium supplementation.Part 2 Application of carbon nanoparticles in localization of parathyroid glands during total parathyroidectomy for secondary hyperparathyroidismThe operative duration was significantly shorter in the TPTX+CN group(P<0.05).Meanwhile,there were no significant differences in i PTH on 1 day and 1 year postoperatively between the two groups(P>0.05).Subgroup analyzed that among patients with 1 or 2 normal sized parathyroid glands,the median operative duration was significantly shorter in the TPTX+CN group than that in the TPTX group(P<0.05),while the difference did not reach statistical significance among patients with no normal sized parathyroid glands(P>0.05).Notably,the i PTH on 1 day and 1 year postoperatively of patients with no normal sized parathyroid glands in the TPTX+CN group was significantly lower than that in the TPTX group(P<0.05).Conclusion1.PPTX would be effective in lowering i PTH for a long period and the incidence of recurrent SHPT might be maintained at a lower level.None of the patients occurred severe hypocalcemia with adequate calcium supplementation.PPTX is safe and effective for patients with SHPT.2.Carbon nanoparticle injection remarkably decreased the operative duration of parathyroidectomy,especially in those with normal sized parathyroid glands.Carbon nanoparticles adequately distinguished the parathyroid gland border and ensured precise and complete resection of parathyroid glands.These findings support that carbon nanoparticle injection is effective and convenient as an assistive modality for TPTX.