Comparison Of Microwave Ablation Therapy In Patients With Secondary And Primary Hyperparathyroidism

Objective:Parathyroidectomy(PTX)is considered as the first choice of treatment for patients with severe uremic secondary hyperparathyroidism(SHPT)and primary hyperparathyroidism(PHPT).Percutaneous ultrasound-guided microwave ablation(M WA)of hyperplastic parathyroid glands may be feasible for patients who are not eligible for PTX or cannot tolerate general anesthesia.The purpose of this study is to evaluate and compare the safety and efficacy of MWA between SHPT group and PHPT group.Methods:This was a retrospective study.SHPT group(n=12)were hospitalized from November,2014 to November,2016 and PHPT group(n=17)were hospitalized from January,2015 to November,2016.The history and baseline clinical characteristics of the two groups were collected and analyzed.All ablation-related adverse events and complications were recorded.The levels of serum intact parathyroid hormone(iPTH)and calcium on the admission and discharge days and at the end of follow-ups were analyzed.Statistical analyses were performed by using software(SPSS version 22).Results:1.Compared with PHPT group,SHPT group manifested the following clinical and laboratory characteristics as well as imaging features:(1)patients were more likely to have malnutrition and anemia;(2)patients had more cardiovascular and pulmonary comorbidities such as coronary artery diseases and pulmonary hypertension;(3)patients had more severe skeletal disorders including ostealgia and arthralgia;(4)laboratory analysis showed that the levels of phosphorus,alkaline phosphatase and iPTH were much higher,while the levels of calcium lower;(5)patients had more hyperplastic parathyroid glands;the volume of those glands were smaller.The above suggests that the ablation procedures,perioperative monitoring as well as follow-ups among patients with uremic SHPT were more complex.2.Compared with PHPT group,SHPT group had the following key points in terms of MWA.:(1)patients were more likely to have risks of bleeding as well as thrombosis,which indicated the modification of certain drugs such as antiplatelets or anticoagulants;(2)the time and power of ablation of a single parathyroid gland were less;patients were required to undergo MWA treatment in separate times to guarantee against the injury to laryngeal nerves;(3)patients were more likely to develop hypocalcemia after MWA and they need immediate treatment of calcium supplements;(4)the levels of iPTH may be elevated after MWA,which indicated that pharmacological therapies after MWA were necessary.Conclusion:Percutaneous ultrasound-guided MWA of hyperplastic parathyroid glands has the merits of feasibility,local anesthesia,repeated operations as well as definite efficacy in the short term.The health declines and mineral and bone disorders of SHPT group were more severe than that of PHPT group.Patients with SHPT usually need additional pharmacological therapies after MWA.The application of MWA in SHPT and PHPT groups differs significantly.Further studies involving large samples are required to determine the safety and efficacy of MWA in such patients.