| Objective:Primary hyperparathyroidism(PHPT)is a common endocrine disease in modern life.The parathyroid tissue itself occurs pathological changes,leading to the increase of parathyroid hormone(PTH)level in the body.Cause calcium and phosphorus metabolism disorder in the body,resulting in systemic multiple system corresponding clinical symptoms.The incidence of PHPT is positively correlated with age and increases with age.Surgery is usually the first choice for patients,which needs to be carried out under general anesthesia.It is highly traumatic to patients,and some patients are unable or unwilling to undergo surgery.Percutaneous microwave ablation(MWA)of parathyroid gland has provided a new treatment method for these patients by minimally invasive treatment under local anesthesia.We aimed to evaluate the safety and clinical efficacy of ultrasonographically-guided percutaneous microwave ablation in the treatment of PHPT.Methods:A total of 35 patients who received MWA treatment in abdominal ultrasound department of our hospital between August,2019 and January,2021 were retrospectively analyzed.Serum parathyroid hormone(PTH),calcium,phosphorus levels,and improvement in clinical symptoms were recorded before and after MWA.All patients were followed up for six months.Paired-sample t-tests and paired sample Wilcoxon signed-rank tests were used to indicate PTH,calcium,and phosphorus levels before and after ablation.Postoperative complications were statistically analyzed to evaluate the safety therapeutic effect of MWA on PHPT patients.Results:A total of 38 parathyroid nodules in 35 PHPT patients were completely ablated at one time.Postoperative follow-up patients,fatigue,osteoporosis,bone pain and other clinical symptoms were effectively improved.11.4%(4/35)of the patients had obvious pain after surgery and were given an ice pack cold compress.The pain was significantly relieved on the second day and was considered to be caused by postoperative thermal injury.14.3%(5/35)of the patients developed mild swallowing foreign body sensation after surgery,which was considered to be related to postoperative edema in the ablation area.8.6%(3/35)of the patients developed hoarseness after surgery,and received an intramuscular injection of 1 dose of 5mg dexametha-sone to reduce the edema of surrounding tissues.Yet,symptoms did not improve 24 hours after surgery,and laryngoscopy examination indicated reduced activity of one side of the vocal cord.During a post-operative follow-up visit,the hoarseness of the patients gradually decreased and returned to normal at about 2 weeks,2 months and 4months after surgery,respectively.94.3%(33/35)of the patients had normal blood PTH levels during postoperative review.In 5.7%(2/35)patients,the PTH level was higher than the normal range at the first and third month after surgery.The recurrence rate after ablation was 5.7%.None of the patients developed tracheal or esophageal injuries,peripheral hematoma,infection,or other serious complications.Conclusions:1.Ultrasound-guided microwave ablation(MWA)is performed under local anesthesia.It provides a new way of treatment for PHPT patients who are not suitable for surgical treatment or cannot bear general anesthesia.2.The combination of ultrasound and ablative therapy can accurately locate the diseased tissue in real time and has strong targeting ability.It has the advantages of safe and effective treatment,less trauma to patients and less complications after surgery.3.Microwave ablation can effectively destroy the parathyroid tissue,reduce the levels of PTH,calcium and phosphorus in the patient’s blood,and has a lasting effect.It can effectively improve the clinical symptoms,improve the quality of life and survival rate of patients. |
PDF Full Text Request