Efficacy Comparison Of The Three Parathyroidectomy Methods In Secondary Hyperparathyroidism

Objectives:To evaluate the clinical efficacy of subtotal parathyroidectomy(SPTX),total parathyroidectomy(TPTX)and parathyroidectomy combined with auto-transplantation(TPTX+AT)in the treatment of renal secondary hyperparathyroidism(SHPT)patients.Methods:A total of 53 SHPT patients were enrolled in this randomized clinical trial during the period from August 2016 to October2017.The patients randomly underwent one type of surgery: SPTX,TPTX or TPTX+AT.Clinical efficacy was evaluated by the changes of intact parathyroid hormone(iPTH),serum phosphorus(P)serum calcium(Ca),and clinical scores,such as bone pain and skin itch.Clinical safety was studied by postoperative complications in each group of patients.Results: Surgical operations were successfully performed in all patients.Bone pain,skin itch,myasthenia and calcification of subcutaneous soft tissue were alleviated to a different extent.The groups of TPTX and TPTX+AT demonstrated more significant improvementthan the group of SPTX in terms of the commonly observed SHPT symptoms of bone pain,skin itch.Serum Ca,P and iPTH reduced significantly 1 week,1 month and 6 months after the operation at in all patients compared with the baseline data.Serum iPTH levels were statistically higher in SPTX group than in TPTX group.No obvious post-operational complications were observed.Conclusion:The type of operations of TPTX +AT is safe and promising to deliver effective treatment in uremic SHPT patients,is a relatively ideal type of operation.