The Efficacy Of Parathyroidectomy In The Treatment Of Refractory Renal Secondary Hyperparathyroidism

Objective To evaluate the short-term and long-term efficacy of parathyroidectomy(PTX)in the treatment of refractory renal secondary hyperparathyroidism(SHPT).Methods 139 cases of end-stage renal disease with SHPT who underwent PTX in our hospital were enrolled.Blood samples including serum calcium,phosphorus,intact parathyroid hormone(i PTH),hemoglobin(Hb),and hematocrit(Hct)were collected from patients with preoperative and postoperative(6 months,1,2,and 3 years).Clinical improvement,anemia improvement,postoperative complications,and follow-up were recorded.Results The success rate was 95.0%(132/139).12 cases(8.6%)developed transient recurrent laryngeal nerve injury and recovered themselves within 3 months after operation.The incidence of hypocalcemia was as high as 86.3%(120 /139),which was effective controlled by active intravenous and/or oral calcium supplementation.Preoperative SHPT symptoms and signs were all relieved after surgery.The degree of anemia has been improved.Hb and Hct increased significantly 6 months after operation,and remained stable during the follow-up period.The weekly use of erythropoietin(EPO)decreased significantly after operation compared with that before operation.The blood levels of i PTH(P < 0.05),calcium(P < 0.05),phosphorus(P <0.05)and calcium-phosphorus product(P < 0.05)in 6 months after operation were significantly lower than those before operation,and the biochemical indexes were still lower than those before operation after 3 years of follow-up.There were 12 cases with persistent SHPT after operation,5 cases with less than 4 parathyroid glands excised during operation,1 case with 4 parathyroid glands excised during operation(one gland was small but not completely excised);the remaining 6 cases had ectopic parathyroid glands in mediastinum after operation.During the follow-up period,6 patients with incomplete glands were remitted after PTX,6 patients with ectopic parathyroid glands refused to reoperate because of the high risk of operation and were treated with drugs.Among 28 cases of recurrence,6 cases were confirmed to be caused by forearm graft recurrence.After forearm graft excision under local anesthesia,i PTH returned to normal(i PTH < 69pg/ml);2 cases were caused by excessive residual gland hyperplasia in situ in the neck,which were treated with second operation and relieved after operation.In the remaining 20 cases,although the level of i PTH increased,the drug treatment was still effective and is still under follow-up.Conclusions PTX is a safe and effective method for the treatment of serious SHPT.