Clinical Efficacy Of Total Parathyroidectomy In Treating Secondary Hyperparathyroidism In Dialysis Patients

ObjectiveTo retrospectivly analyze the clinical features and efficacy of parathyroidectomy in the treatment of secondary hyperparathyroidism in patients receiving maintenance dialysisand the influence factors of postoperative blood calcium levels.MethodsThe clinical data of 519 cases of SHPT treated with PTX from September 2008 to October 2015 were analyzed retrospectively.The changes in calcium,phosphorus,total parathormone,alkaline phosphatase,vascular calcification,bone mineral density and clinical symptoms including bone pain itching were observed before and after parathyroidectomy and follow-up days.Analyzing 34 cases of preoperative and postoperative bone mineral density and studying the change of bone mineral density characteristicsResults1.Among 519 patients,34(6.6%)underwent total parathyroidectomy combined with forearm auto-transplantation,and 485(93.4%)received subtotal parathyroidectomy.Four parathyroid glands were resected in 389(84.95)patients,>4 in 44(8.48%)case and<4 in 88(16.6%)patients.47(9.1%)cases with bone change,462(89.1%)cases with bone pain,350(67.4%)cases with itching,213(41.2%)cases with muscle weakness and 102(19.6%)cases with resstless leg syndrome.Nodular whyperplasia as observed in all 519(100%)cases,and only four cases were diffuse hyperplasia.2.No patient died during the perioperative period.Intraoperatively,12(4%)cases presented with transiently recurrent nerve injury.10(1.9%)cases presented the hematoma,hypocalcemia was observed in 501(96.5%)cases,which has been effectively controlled with intravenous,oral calcium supplements or high calcium dialysis.3.After surgery,the levels of PTH,phosphorus,alkaline phosphatase and bone score,itching score in patients were significantly declined.(all P<0.05).4.After surgery,the incidence of patients with osteoporosis and osteopenia is significantly lower preoperative;Postoperative bone mineral density,bone mineral content and scores obviously improve compared with preoperative,statistically significant;and the more severe osteoporosis in preoperative,and the more obvious improvement in postoperative.5.The percentages change of bone mineral density were correlated to the parathyroid gland resection,preoperative parathyroid hormone,preoperative bone density,etc.ConclusionsPTX is an effective and safe way in the treatment for those patients with SHPT and has a high incidence of hypocalcemia.Postoperative bone mineral density is significantly improved,and correlated to the parathyroid gland resection,preoperative parathyroid hormone,preoperative bone density,etc.