The Study Of Clinical Effects Of Microwave Ablation In The Treatment Of Secondary Hyperparathyroidism

Object:To study the clinical effect of microwave ablation(MWA)and traditional parathyroidectomy(PTX)in the treatment of secondary hyperparathyroidism(SHPT).The value of microwave ablation in the treatment of secondary hyperparathyroidism was analyzed and discussed.Methods:The data of 59 SHPT patients who visited our general surgery department from October 2017 to June 2019 and invited by other hospitals in Qingdao were analyzed retrospectively.According to different treatment methods,the patients were divided into two groups: ultrasonic guided microwave ablation group(MWA group)29 cases and surgical resection group(PTX group)30 cases.The demographic data,clinical data and laboratory test results were recorded,and the differences of operation time,hospitalization days,clinical prognosis,laboratory test results(PTH,blood calcium,blood phosphorus)between the two groups were analyzed.Results:In this study,59 SHPT patients were selected,among them,30 patients in PTX group were male 10(33.3%)and female 20(66.7%),age 51-83(68.5 ± 8.7)years old,maximum diameter of nodule 11.3-27.3(16.8 ± 3.56)mm,weakness 25(83.3%),bone pain 26(86.7%),pruritus 14(46.7%);In MWA group,29 patients were 12(41.4%)male and 17(58.6%)female.The age was 48-89(69.1 ± 9.4)years old,the maximum diameter of nodule was 11.1-24.6(14.7 ± 2.70)mm,the basic serum PTH value was 867-3794(1885.2 ± 744.7)pg / ml,the basic blood calcium value was 2.36-3.27(2.81 ± 0.243)mmol / L,the basic blood phosphorus value was 0.81-3.63(1.89 ± 0.713)mmol / L.There was no significant difference in age and gender between PTX group and MWA group(P > 0.05).The operation time of MWA group was less than that of PTX group(57.3 ± 5.034 min,98.8 ± 7.523 min).The difference between the two groups was statistically significant(t = 11.44,P < 0.01).The amount of intraoperative hemorrhage in MWA group was less than that in PTX group(57.1 ± 7.022 ml,7.69 ± 3.956 ml).There was a significant difference between the two groups(t = 3.495,P < 0.01).The time of getting out of bed in MWA group was shorter than that in PTX group(7.23 ± 1.609 hours,34.6 ± 4.014 hours).The median difference of PTX group was statistically significant(median 3 days,5 days,z = 3.866,P < 0.01).Compared with the PTH value of one hour before operation,the PTH value of the two groups decreased significantly one hour after operation;compared with the PTH value of one hour before operation and one hour after operation,the PTH value continued to decrease and reached the normal level one day after operation;there was no significant difference between the PTX group and MWA group in the PTH value of one day,one week,one month,three months and six months after operation(P > 0.05).There was no significant difference between the two groups(t = 0.410,P = 0.684).There was no significant difference in the blood calcium value of PTX group(t = 0.166,P = 0.869).There was no significant difference in blood calcium between the two groups at 1 week,1 month,3 months and 6 months(P > 0.05).There was a significant difference between the two groups(t = 0.764,P = 0.684).One day after operation,the blood phosphorus value of the two groups continued to decrease,but still higher than the normal value.There was no significant difference between the two groups(t = 0.829,P = 0.412).One month after the operation,the blood phosphorus value of the two groups continued to decline and all decreased to the normal range.There was no significant difference between the two groups(t = 0.375,P = 0.741).PTX and MWA patients did not have perioperative death.The prognosis of surgical wound was good without complications.The patients were discharged smoothly 1 to 2 weeks after operation.There was no significant difference between PTX group and MWA group(P = 0.277).The incidence of hypocalcemia in PTX group was higher than that in MWA group(13.3%,10.3%).There was no significant difference between the two groups(P = 0.723).In the 6-month follow-up,the recurrence rate of PTX group was 1(3.33%)higher than that of MWA group,and the difference was statistically significant(P = 0.026).Conclusion:Short term observation of MWA and PTX in the treatment of SHPT is similar.The results of this study suggest that MWA is more safe,simple,less trauma,fast and short cycle,without general anesthesia to reduce the recovery time of patients,and has high repeatability,which is a fast,effective and safe treatment for SHPT.