Therapeutic evaluation of surgical procedure in treatment of secondary hyperparathyroidism
10.3760/cma.j.issn.1673-0860.2015.08.011
- VernacularTitle:继发性甲状旁腺功能亢进外科治疗的疗效分析
- Author:
Jialin FENG
1
;
Qinyi ZHOU
;
Jun CHEN
;
Yanwen LUO
;
Jiadong WANG
Author Information
1. 200001,上海交通大学医学院附属仁济医院头颈外科
- Keywords:
Hyperparathyroidism,secondary;
Parathyroidectomy;
Technetium Tc 99m sestamibi;
Treatment outcome
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2015;50(8):661-667
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the short-term and long-term outcomes of the three operation methods in treatment of secondary hyperparathyroidism.Methods Clinical data of 88 patients who underwent parathyroidectomy for secondary hyperparathyroidism from October 2004 to October 2014 were reviewed retrospectively.Patients were divided into three subgroups,including subtotal parathyroidectomy (group Ⅰ),total parathyroidectomy with autotransplantation (group Ⅱ) and intraoperative 99Tcm-MIBI radioguided total parathyroidectomy with autotransplantation (group Ⅲ).Their serum calcium,phosphorus,serum iPTH results in the pre-operation,short-term (≤ 6 months) and long term (＞ 6 months) of postoperation were collected and compared.The improvements of clinical symptoms together with the postoperative recurrence rate and the complication data were observed and analyzed.Results The symptoms of all patients were improved after the operation.The short-term postoperative serum calcium,serum iPTH and recurrence rate of Group Ⅰ and group Ⅱ were all not statistically significant.The short-term postoperative serum calcium,iPTH and recurrence rate of group Ⅲ were significantly lower than those of group Ⅰ and group Ⅱ (P ＜ 0.05).Postoperative serum phosphorus values of the three groups had no statistical difference.The operation time of group Ⅲ was significantly shorter than that of group Ⅱ ((77 ± 13)vs (108 ± 17) min,P ＜ 0.05).The positive rates were more accurate in group Ⅲ than in group Ⅱ (98.5％ vs 88.7％,P ＜ 0.05).For the long term follow-up,the postoperative serum calcium,phosphorus,serum iPTH and recurrence rate of group Ⅰ and group Ⅱ were not statistically different.The postoperative recurrence rate of group Ⅲwas lower than that of group Ⅰ and group Ⅱ (3.6％ vs 31.6％ and 21.4％ respectively,P ＜ 0.05).Conclusions Total parathyroidectomy with autotransplantation has a good efficacy to treat secondary hyperparathyroidism.The intraoperative 99Tcm-MIBI radioguided total parathyroidectomy with autotransplantation can find the ectopic and supernumerary glands to improve the success rate of operation.And it also can permit omission of frozen section to reduce the operative time.In the postoperative follow-up,the recurrence rate is low,so it is a safe and effective treatment.
