Surgical management for persistent and recurrent renal hyperparathyroidism
10.3760/cma.j.issn.1007-631X.2019.09.006
- VernacularTitle: 持续性和复发性肾性甲状旁腺功能亢进的外科治疗
- Author:
Peng ZHOU
1
;
Qingqing HE
1
;
Dayong ZHUANG
1
;
Jian ZHU
1
;
Tao YUE
1
;
Xiaolei LI
1
;
Meng WANG
1
;
Fang YU
1
;
Changrui LIU
1
Author Information
1. Department of Thyroid and Breast Surgery, the 960th Hospital of the People′s Liberation Army of China, Jinan 250031, China
- Publication Type:Journal Article
- Keywords:
Hyperparathyroidism, secondary;
Recurrence;
Reoperation
- From:
Chinese Journal of General Surgery
2019;34(9):766-770
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the surgical treatment strategies for persistent and recurrent parathyroidectomy after total parathyroidectomy plus autotransplantation(tPTX+ AT) in cases of renal hyperparathyroidism.
Methods:From Oct 2009 to Oct 2018, 480 patients with renal hyperparathyroidism received tPTX+ AT in our hospital. 32 patients suffered from post-op persistent (31) and recurrent (1) hyperparathyroidism .The high frequency ultrasonography combined with fine needle puncture eluent PTH determination and SPECT/CT co-computed tomography fusion imaging were used as qualitative and localizing diagnostic methods before reoperation.
Results:Of the 32 patients, 28 cases underwent reoperation for once, and 4 underwent reoperations fort wice. 36 parathyroid glands and 2 grafts were resected.In 31 patients the bone pain, skin pruritus relieved significantly or disappeared, and muscle strength gradually increased compared with that before operation. Level of iPTH in 31 patients fluctuated between 15 and 90 ng/L. Postoperative parathyroid hormone decreased compared with that before the operation (P<0.05). One patient was still with persistent hyperparathyroidism despite reoperation, whose iPTH fluctuated between 550 and 1 000 ng/L during 6 months to 2 years follow-up.
Conclusion:Ultrasonography, FNA-iPTH and SPECT/CT co-computed tomography can be used as methods for qualitative and localizing diagnosis of PTPT or PHPT.With accurate preoperative localization, resection of all parathyroid glands is an effective treatment for posto perative persistent and recurrent renal hyper parathyroidism.
