Total Parathyroidectomy With Trace Parathyriod Tissue Autotransplantation As The Treatment Of Choice For Secondary Hyperparathyriodism In Clinical Application

ObjectiveObjective To evaluate the clinical safety and effectiveness of total parathyroidectomy with autotransplantation on the chronic renal failure(CRF)patients who are suffering from severe secondary hyperparathyroidism(SHPT).MethodsWe analyzed 149 patients with secondary hyperparathyroidism who were given total parathyroidectomy with autotransplantation from April 2010 to October 2015.The objectives include dialysis age,the numbers of parathyroid resected,pathologies,clinical symptoms such as skin and bone condition and the incidences of postoperative complications.Changes of clinical symptoms(including skeletal muscle or joint pain,pruritus),intact parathyroid hormone,calcium,phosphorus and alkaline phosphatase levels were followed up for 6 months to 6 years.Results598 parathyroid glands were found in 149 patients who underwent surgical resection,including 8 patients who were operated with Da Vinci Si surgical system.Parathyroid numbers are: 140 cases with 4 parathyroids,6 cases with 5,2 cases with 3,1 case with 2.Parathyroid pathologies are concluded as 590 cases of hyperplasia,8 cases of adenoma,and thyroid pathologies as 6 cases of thyroid papillary microcarcinoma which were resectd through total thyroidectomy with central dissection.145 cases of postoperative musculoskeletal pain,skin itching were relieved or disappeared,and the rest of the patients gradually relieved after one week;iPTH,calcium and phosphate blood levels returned to nomal level..Serum intact parathyroid hormone,serum calcium decreasedcompared with preoperative.Two patients had postoperative pathological fractures:1 case of severe postoperative hypocalcemia resulted in muscle twitching scapula fracture,the other one resulted in femoral neck fracture.6 months to 6 years' follow-up showed that :14 patients are with iPTH <15ng / L and 127 patients wih PTH fluctuations between 15-150 ng / L;Two patients with secondary hyperparathyroidism are in persistent state;6 cases had recurrences,and 5 of them underwent secondary surgeries,the other one is still being followed.One patient died of pulmonary infection in 13 months from the surgery.ConclusionTotal parathyroidectomy with autotransplantation were applied to ineffective medical treatment for secondary hyperparathyroidism in patients with chronic renal failure during middle and late stages.