Effect Of Total Parathyroidectomy With Improved Autotransplantation For Secondary Hyperparathyroidism

Objective To investigate the effect of total parathyroidectomy with improved autotransplantation(TPTX+IAT)in the treatment of uremic secondary hyperparathyroidism(SHPT).Methods The clinical data of SHPT patients who underwent TPTX+AT surgery in the People's Hospital of Guangxi Zhuang Autonomous Region from February 1,2015 to December 31,2017 were collected,and divided into traditional group(group A:10 transplants)and improved group(group B:5transplants)according to the number of parathyroid tissue particles(1×1×1 mm~3)transplanted into forearm.Statistical analysis was performed on postoperative serum biochemical parameters such as intact parathyroid hormone(i PTH),serum calcium,serum phosphorus,calcium-phosphorus product,and postoperative symptom remission.The postoperative hospital stay,postoperative symptom remission,related biochemical indicators and recurrence rate of SHPT were compared between the two groups.Results A total of 36 patients were included in this study,including 25patients in group A and 11 patients in group B.On the first postoperative day,the iPTH was reduced to normal levels in both groups.Symptoms such as bone pain and pruritus eased or disappeared within 1 week,and bone deformation and shortened height did not progress after the operation.There was no significant difference between the two groups(P>0.05).The average postoperative hospital stay was 10.20?3.16 days in group A and 10.55?2.95 days in group B,P>0.05.The postoperative serum iPTH,serum calcium,serum phosphorus,calcium and phosphorus products in the two groups were significantly decreased compared with preoperative within one week,three months,six months,twelve months,and 24 months postoperatively,and the differences were statistically significant(P(27)0.05).The iPTH in group B was significantly lower than group A at postoperative 3 months,6 months,and 12 months(P(27)0.05).There was no significant difference between two groups in the other biochemical indicators(P>0.05).The incidence of postoperative numbness of lips or fingertips,and pulmonary infection in group A and B was 20%(5/25)and 18%(2/11),8%(2/25)and 9%(1/11).Complications were all cured after treatment,and there was no significant difference between the two groups(P>0.05).One patient in Group A had recurrent disese at 12 months postoperatively with a recurrence rate of 4%.No recurrence was observed in Group B.There was no significant difference between the two groups(P>0.05).Conclusion TPTX+AT can safely and effectively improve clinical symptoms and reduce serum iPTH,serum calcium and serum phosphorus levels in patients with SHPT.The recurrence rate of TPTX+IAT was not significantly different from that of conventional TPTX+AT,and the levels of serum calcium,serum phosphorus,and calcium-phosphorus products were similar.There was no significant difference in the efficacy and complications of TPTX+IAT compared with traditional TPTX+AT,but the autotransplantation of parathyroid glands was reduced by a factor of more than half,which may be a superior surgical procedure for the treatment of SHPT.