Surgical Treatment Of Secondary Hyperparathyroidism In Patients With Maintenance Hemodialysis

Objective: to retrospectively analyze the clinical data of 31 hemodialysis patients who underwent parathy-roidectomy with autotransplantation(PTX + AT)in the first people's hospital of guiyang county,chenzhou city from May 2016 to August 2019,and to analyze and discuss the clinical efficacy and safety of hemodialysis patients with PTX + AT combined with secondary hyperparathyroidism.Research contents and methods: Collection in May 2016 to August 2019 in the first people's hospital of chenzhou guiyang county PTX + 31 cases of hemodialysis patients treated AT the general information(include the primary disease,gender,age,while undergoing surgery of dialysis,etc.),preoperative and postoperative 1 day,1 month after operation,postoperative march,June after testing the blood calcium(Ca),blood phosphorus(P),serum parathyroid hormone by segment(iPTH)and alkaline phosphatase(ALP)levels,comparative analysis,compare the preoperative and postoperative 1 month,3 months after the patient's hemoglobin and systolic pressure,diastolic blood pressure change,The relieves of postoperative bone pain,skin pruritus and restless leg syndrome were analyzed,and the success rate,recurrence rate,postoperative complications and persistent hypoparathyroidism were calculated.Results: Among the 31 patients included,21 were males and 10 were females,with an average age of 38.4±11.9 years and an average age of 67.3±16.9 months.Primary pathogenesis: 28 cases of chronic nephritis(90.3%),1 case of diabetic nephropathy(3.2%),2 cases of polycystic kidney disease(6.5%).The levels of serum calcium,serum phosphorus,iPTH and ALP in 31 patients after surgery were significantly lower than those before surgery(P < 0.05).Bone pain,skin pruritus and restless leg syndrome were significantly improved(P < 0.05).After 1 month and 3 months,the hemoglobin level increased(P< 0.05),systolic blood pressure(P< 0.05)and diastolic blood pressure(P< 0.05).The success rate was 96.7%.The serum calcium level of all patients decreased after the operation compared with that before the operation,and 28 patients(90.3%)developed hypocalcemia,among which 6(19.3%)had severe hypocalcemia reaction,which was effectively controlled after active calcium supplementation.Transient hoarseness occurred in 2 patients(incidence: 6.5%),and all patients recovered spontaneously within 1 month.Postoperative incision bleeding was severe in 2 patients(the incidence rate was 6.5%).Twenty-one of the patients were followed up for 14 months,and one developed persistent thyroidia.Conclusion: Parathyroidectomy and autologous transplantation is an effective method for the treatment of severe SHPT with a high success rate.The most common postoperative complication is hypocalcemia,with a certain recurrence rate of hyperparathyroidism and persistent hypoparathyroidism.However,this study is a single-center study with a small sample size and a short follow-up time,so a randomized controlled study with a large sample is needed to observe the efficacy and safety of PTX in the treatment of SHPT in hemodialysis patients.