Efficacy of Subtotal Parathyroidectomy and Total Parathyroidectomy Plus Parathyroid Autotransplantation in Treatment of Secondary Hyperparathyroidism_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZOUhong-lei ¹ ,  YANGshu-fen ² , ZhAOtian-tian ²

1. Military Ward, Xinjiang Armed Police Corps Command Military hospital, Urumqi 830000, Xinjiang Uygur Autonomous Region, China;
2. Department of Nephrology, the Xinjiang Uygur Autonomous Region People's hospital, Xinjiang Uygur Autonomous Region, China;

Corresponding author：

YANGshu-fen, Email: yshzhl5115@163.com

Keywords：

Secondary hyperparathyroidism; Subtotal parathyroidectomy; Total parathyroidectomy; Autotransplatation; Effect

DOI：

10.7507/1007-9424.20140173

Video：

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Objective To compare the efficacy of subtotal parathyroidectomy(sPTX) and total parathyroidectomy (tPTX) plus parathyroid autotransplantation(AT) in treatment of secondary hyperparathyroidism(SHPT). Methods Clinical data of 76 cases of uremia SHPT who underwent sPTX(n=19) and tPTX+AT(n=57) in Xinjiang Armed Police Corps Command Military Hospital and The Xinjiang Uygur Autonomous Region People's Hospital were retrospectively analyzed(from Feb. 2005 to Sep. 2012). Results Of the 76 cases, 68 cases(89.5%) got successful surgery and 8 cases (10.5%) suffered non-complete resection, all cases had relief on bone pain, and 14 cases had relief on pruritus(26.9%, 14/52). The values of serum calcium on 1 day, 7 days, and 6 months after operation were lower in tPTX+AT group (P<0.05), and value of iPTH in 6 months after operation was lower too(P<0.05). The operation time, blood loss, hospital stay, and hospital cost in tPTX+AT group were all higher or longer(P<0.05). All of the 76 cases were followed up for 6-18 months(the median time was 8.7 months). During the followed-up, 2 cases died and 2 cases recurred in tPTX+AT group, 1 case died and 7 cases recurred in sPTX group, that the recurrence rate was higher in sPTX group (P<0.05). Conclusion tPTX+AT has lower recurrence rate, but with longer operation time and hospital stay, more blood loss, and expensive cost, so the choice of surgery for SHPT should be based on the comprehensive situation.

Citation： ZOUhong-lei, YANGshu-fen, ZhAOtian-tian. Efficacy of Subtotal Parathyroidectomy and Total Parathyroidectomy Plus Parathyroid Autotransplantation in Treatment of Secondary Hyperparathyroidism. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(6): 731-734. doi: 10.7507/1007-9424.20140173 Copy

1.	花瞻,姚力,张凌.继发性甲状旁腺功能亢进的外科治疗[J].临床内科杂志, 2012, 29(5):305-307.
2.	Bellprin-Font E, Ambrosoni P, Carlini RG, et al.Clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of mineral and bone disorders in chronic kidney disease (CKD-MBD) in adults[J].Nefrologia, 2013, 33 Suppl 1:1-28.
3.	Tominaga Y, Matsuoka S, Uno N, et al.Removal of autografted parathyroid tissue for recurrent renal hyperparathyroidism in hemodialysis patients[J].World J Surg, 2010, 34(6):1312-1317.
4.	Coresh J, Selvin E, Stevens LA, et al.Prevalence of chronic kidney disease in the United States[J].JAMA, 2007, 298(17):2038-2047.
5.	Li S, Chen YW, Peng Y, et al.Trends in parathyroidectomy rates in US hemodialysis patients from 1992 to 2007[J].AMJ Kidney Dis, 2011, 57(4):602-611.
6.	张建荣,张凌.慢性肾脏病继发性甲旁亢[M].北京:人民军医出版社, 2010:143-145.
7.	刘君,王家东.甲状旁腺切除术治疗继发性甲状旁腺功能亢进[J].中国耳鼻咽喉头颈外科, 2005, 12(7):427-429.
8.	王金,徐祗顺,姜光洲,等.原发性甲状旁腺功能亢进症20例[J].中国现代普通外科进展, 2005, 8(4):256.
9.	Tominaga Y, Matsuoka S, Sate T.Surgical indications and procedures of parathyroidectomy in patients with chronic kidney disease[J].Ther Apher Dial, 2005, 9(1):44-47.
10.	张凌,王文博.继发性甲状旁腺功能亢进症的不同甲状旁腺切除术式治疗[J].中国血液净化, 2011, 10(5):236-238.
11.	Dotzenrath C, Cupisti K, Goretzki E, et al.Operative treatment of renal autonomous hyperparathyroidism:cause of persistent or recurrent disease in 304 patients[J].Langenbecks Arch Surg,2003, 387(9-10):348-354.
12.	李海明,顾勇,薛骏,等.甲状旁腺全切除加前臂移植治疗尿毒症继发性甲状旁腺功能亢进[J].中华肾脏病杂志, 2006, 22(4):197-200.
13.	Blacher J, Guerin AP, PannierB, et al.Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease[J].Hypertension, 2001, 38(4):938-942.
14.	Decker PA, Cohen EP, Doffek KM, et al.Subtotal parathyroidectomy in renal failure:still needed after all these years[J].World J Surg, 2001, 25(6):708-712.
15.	姚力,张凌,刘鹏,等.甲状旁腺切除术治疗难治性甲状旁腺功能亢进症89例疗效评价[J].中国血液净化, 2009, 8(8):431-436.
16.	张媛元,郑尘飞,孙文学,等.尿毒症继发性甲状旁腺亢进两种手术方式的疗效比较[J].中国中西医结合肾病杂志, 2008, 9(8):710-712.
17.	Dotzenrath C, Cupisti K, Goretzki E, et al.Operative treatment of renal autonomous hyperparathyroidism:cause of persistent or recurrent disease in 304 patients[J].Langenbecks Arch Surg, 2003, 387(9-10):348-354.
18.	Schneider R, Kolios G, Koch BM, et al.An economic comparison of surgical and medical therapy in patients with secondary hyperparathyroidism-the German perspective[J].Surgery, 2010, 148(6):1091-1099.
19.	Corneci M, Stanescu B, Trifanescu R, et al.Perioperative management difficulties in parathyroidectomy for primary versus secondary and tertiary hyperparathyroidism[J].Maedica (Buchar), 2012, 7(2):117-124.
20.	Richards ML, Wormuth J, Bingener J, et al.Parathyroidectomy in secondary hyperparathyroidism:is there an optimal operative management?[J].Surgery, 2006, 139(2):174-180.
21.	Fukagawa M, Yumita S, Akizawa T, et al.Cinacalcet (KRN1493) effectively decreases the serum intact PTH level with favorable control of the serum phosphorus and calcium levels in Japanese dialysis patients[J].Nephrol Dial Transplant, 2008, 23(1):328-335.
22.	Stanbury SW, Lumb GA, Nicholson WF.Elective subtotal parathyroidectomy for renal hyperparathyroidism[J].Lancet, 1960, 1(7128):793-799.
23.	Kraimps JL, Marechaud R, Gineste D, et al.Analys and prevention of recullent goiter[J].Surg Gynecol Obstet, 1993, 176(4):319-322.
24.	邓如岗,王志明,吕新生,等.结节性甲状腺肿的外科治疗[J].中国普通外科杂志, 2004, 13(5):343-345.

1. 花瞻,姚力,张凌.继发性甲状旁腺功能亢进的外科治疗[J].临床内科杂志, 2012, 29(5):305-307.
2. Bellprin-Font E, Ambrosoni P, Carlini RG, et al.Clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of mineral and bone disorders in chronic kidney disease (CKD-MBD) in adults[J].Nefrologia, 2013, 33 Suppl 1:1-28.
3. Tominaga Y, Matsuoka S, Uno N, et al.Removal of autografted parathyroid tissue for recurrent renal hyperparathyroidism in hemodialysis patients[J].World J Surg, 2010, 34(6):1312-1317.
4. Coresh J, Selvin E, Stevens LA, et al.Prevalence of chronic kidney disease in the United States[J].JAMA, 2007, 298(17):2038-2047.
5. Li S, Chen YW, Peng Y, et al.Trends in parathyroidectomy rates in US hemodialysis patients from 1992 to 2007[J].AMJ Kidney Dis, 2011, 57(4):602-611.
6. 张建荣,张凌.慢性肾脏病继发性甲旁亢[M].北京:人民军医出版社, 2010:143-145.
7. 刘君,王家东.甲状旁腺切除术治疗继发性甲状旁腺功能亢进[J].中国耳鼻咽喉头颈外科, 2005, 12(7):427-429.
8. 王金,徐祗顺,姜光洲,等.原发性甲状旁腺功能亢进症20例[J].中国现代普通外科进展, 2005, 8(4):256.
9. Tominaga Y, Matsuoka S, Sate T.Surgical indications and procedures of parathyroidectomy in patients with chronic kidney disease[J].Ther Apher Dial, 2005, 9(1):44-47.
10. 张凌,王文博.继发性甲状旁腺功能亢进症的不同甲状旁腺切除术式治疗[J].中国血液净化, 2011, 10(5):236-238.
11. Dotzenrath C, Cupisti K, Goretzki E, et al.Operative treatment of renal autonomous hyperparathyroidism:cause of persistent or recurrent disease in 304 patients[J].Langenbecks Arch Surg,2003, 387(9-10):348-354.
12. 李海明,顾勇,薛骏,等.甲状旁腺全切除加前臂移植治疗尿毒症继发性甲状旁腺功能亢进[J].中华肾脏病杂志, 2006, 22(4):197-200.
13. Blacher J, Guerin AP, PannierB, et al.Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease[J].Hypertension, 2001, 38(4):938-942.
14. Decker PA, Cohen EP, Doffek KM, et al.Subtotal parathyroidectomy in renal failure:still needed after all these years[J].World J Surg, 2001, 25(6):708-712.
15. 姚力,张凌,刘鹏,等.甲状旁腺切除术治疗难治性甲状旁腺功能亢进症89例疗效评价[J].中国血液净化, 2009, 8(8):431-436.
16. 张媛元,郑尘飞,孙文学,等.尿毒症继发性甲状旁腺亢进两种手术方式的疗效比较[J].中国中西医结合肾病杂志, 2008, 9(8):710-712.
17. Dotzenrath C, Cupisti K, Goretzki E, et al.Operative treatment of renal autonomous hyperparathyroidism:cause of persistent or recurrent disease in 304 patients[J].Langenbecks Arch Surg, 2003, 387(9-10):348-354.
18. Schneider R, Kolios G, Koch BM, et al.An economic comparison of surgical and medical therapy in patients with secondary hyperparathyroidism-the German perspective[J].Surgery, 2010, 148(6):1091-1099.
19. Corneci M, Stanescu B, Trifanescu R, et al.Perioperative management difficulties in parathyroidectomy for primary versus secondary and tertiary hyperparathyroidism[J].Maedica (Buchar), 2012, 7(2):117-124.
20. Richards ML, Wormuth J, Bingener J, et al.Parathyroidectomy in secondary hyperparathyroidism:is there an optimal operative management?[J].Surgery, 2006, 139(2):174-180.
21. Fukagawa M, Yumita S, Akizawa T, et al.Cinacalcet (KRN1493) effectively decreases the serum intact PTH level with favorable control of the serum phosphorus and calcium levels in Japanese dialysis patients[J].Nephrol Dial Transplant, 2008, 23(1):328-335.
22. Stanbury SW, Lumb GA, Nicholson WF.Elective subtotal parathyroidectomy for renal hyperparathyroidism[J].Lancet, 1960, 1(7128):793-799.
23. Kraimps JL, Marechaud R, Gineste D, et al.Analys and prevention of recullent goiter[J].Surg Gynecol Obstet, 1993, 176(4):319-322.
24. 邓如岗,王志明,吕新生,等.结节性甲状腺肿的外科治疗[J].中国普通外科杂志, 2004, 13(5):343-345.

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Efficacy of Subtotal Parathyroidectomy and Total Parathyroidectomy Plus Parathyroid Autotransplantation in Treatment of Secondary Hyperparathyroidism

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