Clinical outcomes of total parathyroidectomy with forearm autotransplantation in the treatment of secondary hyperparathyroidism
10.7659/j.issn.1005-6947.240424
- VernacularTitle:甲状旁腺全切除术联合前臂甲状旁腺自体移植术治疗继发性甲状旁腺功能亢进的临床效果
- Author:
Guojin LI
1
;
Yin SU
;
Zhongqiang WU
;
Jinsong HE
;
Junqiang TAN
;
Yanghao LONG
Author Information
1. 广东省高州市人民医院 甲状腺外科,广东 高州 525200
- Publication Type:Journal Article
- Keywords:
Parathyroidectomy;
Transplantation,Autologous;
Hyperparathyroidism,Secondary
- From:
Chinese Journal of General Surgery
2025;34(5):937-944
- CountryChina
- Language:Chinese
-
Abstract:
Background and Aims:Secondary hyperparathyroidism(SHPT)is a common and difficult-to-treat complication of chronic kidney disease(CKD),significantly impairing patients'quality of life and prognosis.For patients who respond poorly to medical therapy,surgical intervention remains an effective treatment option.This study aimed to evaluate the clinical efficacy and safety of total parathyroidectomy with forearm autotransplantation(tPTX+AT)in the treatment of CKD-related SHPT.Methods:A retrospective analysis was conducted on 40 patients with CKD complicated by SHPT who underwent tPTX+AT in Gaozhou People's Hospital between January 2020 and June 2023.Changes in intact parathyroid hormone(iPTH),serum phosphorus,calcium,alkaline phosphatase(ALP),and bone mineral density(BMD)were recorded preoperatively and at multiple postoperative time points.Postoperative symptom relief,complications,and follow-up outcomes were also analyzed.Results:A total of 158 parathyroid glands were removed during surgery.Among the patients,38 had four glands successfully excised,while two had only three glands removed.After operation,levels of iPTH,phosphorus,calcium,and ALP decreased significantly compared to preoperative values(all P<0.05),and BMD increased significantly at 3 months(P<0.05).Symptoms such as bone pain,pruritus,and restless leg syndrome improved markedly by 3 months postoperatively(all P<0.05).Hypocalcemia occurred in 34 cases(85.0%);one patient experienced transient recurrent laryngeal nerve injury and one had superior laryngeal nerve injury,both of which resolved after treatment.The two patients who had only three glands removed exhibited persistent SHPT postoperatively,with iPTH levels of 457 pg/mL and 609 pg/mL,respectively.Although their symptoms improved partially,the condition was medically controlled without the need for reoperation.Conclusion:tPTX+AT can effectively correct mineral metabolism disorders and improve BMD and clinical symptoms in SHPT patients.The procedure achieves a high rate of complete gland resection and stable autograft function.Although postoperative hypocalcemia is common,overall complications are manageable.This surgical approach is safe and effective for the treatment of refractory SHPT.
