Analysis Of Surgical Clinical Treatment Of Secondary Hyperparathyroidism And Application Of Intraoperative Rapid Detection Of PTH

Objective: To compare the clinical efficacy of interventional procedures and surgical procedures in the treatment of secondary hyperparathyroidism;to investigate the effectiveness of intraoperative parathyroid hormone in parathyroidectomy.Methods: Ninety-seven patients with secondary hyperparathyroidism who attended our hospital from September 2019 to September 2021 were selected for the study,and were divided into interventional（n=23）and surgical（n=74）groups according to their treatment methods.The expression levels of parathyroid-hormone（PTH）,blood calcium,blood phosphorus and other laboratory indicators were measured before and after surgery in both groups,as well as the remission of clinical symptoms after treatment.At the same time,postoperative complications and recurrence were compared between the two groups to evaluate the efficacy of different clinical treatment regimens.Results: The success rate of surgery was 91.8% in 97 patients.Joint pain,skin pruritus,and muscle weakness scores were lower in the interventional and surgical groups than before surgery（P<0.05）.After the surgery,blood whole segment parathyroid hormone,blood calcium,and blood phosphorus levels in both groups were different at 1d,1 week,and 1 month compared with preoperative（P<0.05）.Clinical complications after treatment were lower in the surgical group than in the interventional group,but the difference between the two groups of patients was not significant（P=0.136 > 0.05）.In the group applying intraoperative parathyroid hormone test in parathyroidectomy,PTH≤150 p g/m L in 4 patients,PTH10/PTH0≤ 30% in 7 patients,and partial resection of residual parathyroid glands in 2 patients due to high intraoperative PTH detection level.PTH10/PTH0> 30% in 1 patients,in this patient,the PTH10 value was 546.79 pg/m L after resection of the three parathyroid glands,which did not meet the requirement for cure,Again,carefully check around the thyroid gland,around the carotid artery,and tracheal and esophageal grooves,4th parathyroid gland did not found.In the 13 patients with successful surgery,PTH was monitored on the postoperative seventh day,we found PTH<15 pg/m L in 3 patients,between 15 and 65 pg/m L in 6 patients,and between 65 and 150 pg/m L in 4 patients.In the case of failed surgery,PTH levei is 522.9 pg/m L on the postoperative seventh day,the cause of failure did not exclude the influence of ectopic parathyroid glands.Conclusion: Both interventional and surgical treatment can significantly improve the patient’s laboratory parameters and relieve clinical symptoms,but each treatment has its own advantages and disadvantages,which requires us continuous research and improvement.In the selection of clinical treatment options,it is necessary to first take into account the patient’s medical history and the experience of the operator,as well as the medical level of the medical institution,thus adopt a variable and flexible treatment approach.