Sequential parathyroidectomy under cervical plexus anesthesia for secondary hyperparathyroidism with renal function failure
10.3760/cma.j.issn.0529-5815.2018.07.009
- VernacularTitle:颈丛阻滞麻醉下分期手术治疗继发性甲状旁腺功能亢进症的初步探索
- Author:
Ya HU
1
;
Surong HUA
;
Mengyi WANG
;
Zhe SU
;
Ming CUI
;
Xiang ZHANG
;
Quan LIAO
;
Yupei ZHAO
Author Information
1. 100730,中国医学科学院北京协和医学院北京协和医院基本外科
- Keywords:
Hyperparathyroidism,secondary;
Parathyroidectomy;
Renal insufficiency,chronic
- From:
Chinese Journal of Surgery
2018;56(7):528-532
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize the strategy of sequential parathyroidectomy for secondary hyperparathyroidism.Methods Between January 2009 and December 2017,32 patients with secondary hyperparathyroidism underwent parathyroidectomy in Department of General Surgery,Peking Union Medical College Hospital.There were 11 male and 21 female patients with a mean age of 51.3 years.Eleven of them underwent bilateral neck exploration under general anesthesia,while the rest of them underwent sequential parathyroidectomy.For the patients with sequential parathyroidectomy,a unilateral neck exploration was performed in the initial operation under cervical plexus blocking anesthesia.Second operation for contralateral parathyroid lesions was performed if the serum intact parathyroid hormone (iPTH) was still higher than 1 000 ng/L or related symptoms were not relieved significantly 6 months later after initial surgery.Fisher exact test was used to compare the date between the 2 groups.Results In the bilateral exploration group,the serum iPTH level gradually exceeded above 1 000 ng/L in 5 patients during followup,and reoperation were performed in 3 patients of them.In the group with sequential parathyroidectomy,the serum iPTH level after initial operation exceeded above 1 000 ng/L in 15 patients.Eleven of them underwent contralateral parathyroidectomy,which decreases the serum iPTH levels to less than 1 000 ng/L in 10 patients.Compared with the sequential parathyroidectomy group (1/11),more patients needed to be treated in the intensive care unit after operation in bilateral exploration group (6/11),although the difference was statistically insignificant (P=0.063).Conclusions Sequential parathyroidectomy strategy is feasible for the secondary hyperparathyroidism with severe complications.Prospective controlled observation with large sample size is needed to confirm its effect.
