Objective To analysis causes of reoperation for primary hyperparathyroidism and its clinical characteristics. Method The clinical data of the patients with primary hyperparathyroidism who had undergone reoperation from January 1993 to May 2017 were retrospectively analyzed. Results A total of 11 patients underwent reoperation were collected in the 226 patients with primary hyperparathyroidism. Of the 11 cases, 8 cases underwent twice operations, 2 cases underwent thrice operations, 1 case underwent quintic operation. After the initial operation, 3 cases were persistent diseases and 7 cases were recurrent diseases, 1 patient was not defined as the persistent or recurrent disease. The main clinical manifestations before the reoperation were fatigue, pain in joints, bones, or muscle. The reasons for reoperation included 3 cases of ectopic parathyroid lesions, 3 cases of recurrent parathyroid carcinomas, 1 case of enlarged operation extent for parathyroid carcinoma, 2 cases of regrowth of double parathyroid aedomas, 1 case of missing adenoma, 1 case of parathyroid hyperplasia. Among the location examinations, the 99Tcm-MIBI was most sensitivity (8/9). Eight cases were received reoperation on the original incision, and the remaining 3 ectopic parathyroid lesions on the new incision. After the reoperation, 2 patients were lost of follow-up, 1 patient died, and the remaining 8 patients had no recurrences during follow-up period. Conclusion A comprehensive approach with multiple imageology examinations which attribute to accurate location of lesions, experienced surgeons and well knowledge of parathyroid anatomy and embryology help to descend reoperation ratio and improve success rate of reoperation.
Vague preoperative localization and ectopic parathyroid often lead to the failure of operation in primary hyperparathyroidism. From Jun 1989 to March 1998, 11 cases of primary hyperparathyroidism had been treated surgically in the general surgery department of our hospital. Of them, 10 cases were operated successfully with the pathological diagnosis of adenoma and one parathyroid removed was reported normal. Preoperative localization, the knowledge of ectopic parathyroids, careful exploration during operation and the postoperative medical treatment are important for the perioperative management. Postoperative followup has emphasized to benefit the treatment in primary hyperparathyroidism.
Objective To explore the application value of intraoperative gamma detector in patients with chronic kidney disease secondary hyperparathyroidism (sHPT) undergoing total parathyroidectomy (tPTX)+auto transplantation (AT). Methods A retrospective analysis of the clinical data of 110 sHPT patients who received tPTX+AT at Northern Jiangsu Province People’s Hospital from July 2014 to June 2019 was performed. Among them, 80 patients underwent tPTX+AT guided by the gamma detector during the operation (observation group), 30 patients underwent tPTX+AT under routine exploration (control group). We compared the operation time, number of parathyroid glands removed, serum intact parathyroid hormone (iPTH) concentration, serum calcium and phosphorus levels, as well as the occurrence of postoperative complications and recurrence rate were compared between the two groups. Results The number of parathyroid glands removed of the control group was lower than that of the observation group [(3.87±0.35) per case vs. (4.01±0.11) per case, P<0.05], but the operation time of the control group was longer [(115±25) min vs. (75±27) min, P<0.05]. Postoperative iPTH, serum calcium and serum phosphorus levels were significantly reduced in all patients. After the operation, the symptoms of pruritus, bone pain, and muscle weakness were relieved or disappeared. There was no death, dysphagia, drinking water choking cough, and superior laryngeal nerve injury occurred. One patient in the observation group and one patient in the control group had hoarseness, and one patient in the control group had cervical incision bleeding; one patient in the observation group and four patients in the control group suffered short-term postoperative recurrence due to incomplete parathyroidectomy. There was no significant difference in the incidence of complications (χ2=2.413, P>0.05), but the short-term postoperative recurrence rate of the observation group was lower than that of the control group (χ2=7.342, P<0.05). Conclusion Gamma detector is helpful for rapid identification of typical hyperplasia and ectopic parathyroid glands during operation, and can improve the accuracy of tPTX , save operation time, and reduce the recurrence.
ObjectiveTo investigate the role of multiple disciplinary team (MDT) during surgical treatment of renal secondary hyperparathyroidism (SHPT), and identify management points of Departments of Nephrology and Endocrinology.MethodsThe data of patients with chronic kidney disease undergoing surgical treatment for SHPT in West China Hospital of Sichuan University between January 2009 and December 2018 were retrospectively collected. We explained the surgical treatment of MDT in the management of renal SHPT, and compared the changes before and after the establishment of MDT.ResultsA total of 187 patients including 101 males and 86 females were enrolled, with an average age of (47.60±11.28) years old and median dialysis vintage of 7 years. Under MDT, the number of patients with parathyroidectomy increased [(8.50±5.10) vs. (59.50±2.12) patients/year, P<0.001] and the completion rate of preoperative examinations were greatly improved (P<0.001). The success rate of surgery was also increased (86.8% vs. 97.5%, P=0.010). Proportion of patients who were admitted to the Department of Nephrology was significantly increased (39.7% vs. 84.9%, P<0.001). Most patients after surgery were transferred to the Department of Endocrinology (5.9% vs. 77.3%, P<0.001) to manage postoperative complications and metabolic bone disease, and thus normalized the management of SHPT.ConclusionsThe MDT contributes to management of renal SHPT, which is worthy of popularization and spreading. The management of internal medicine departments during surgical treatment of SHPT based on MDT is important, because they can be helpful to complete preoperative examinations and preoperative preparation as well as to alleviate postoperative complications.
ObjectiveTo compare the clinical effects of unilateral neck exploration (UNE) and direct minimally invasive parathyroidectomy (DPT) in the treatment of primary hyperparathyroidism (PHPT). MethodsThe clinical datas of 87 PHPT patients treated with intraoperative parathyroid hormone monitoring (IPM) -assisted UNE and DMIP in Guizhou Provincial People’s Hospital between January 2016 and December 2021 were analyzed retrospectively. ResultsThe average age of patients was (47.5±13.1) years, and there were 24 males (27.6%) and 63 females (72.4%). The pathological types of 87 cases were parathyroid adenoma in 78 cases (89.7%), atypical parathyroid adenoma in 5 cases (5.7%), parathyroid hyperplasia in 4 cases (4.6%), and no parathyroid carcinoma. Two cases (2.3%) developed recurrent laryngeal nerve injury, and 3 cases (3.4%) developed postoperative persistent hyperparathyroidism, of which 1 (1.1%) case underwent secondary surgery. There were no significant differences in the incidence of recurrent laryngeal nerve injury (2.0% vs. 2.6%, P=0.855) and postoperative persistent hyperparathyroidism between the UNE group and the DMIP group (2.0% vs. 5.3%, P=0.713). However, the intraoperative bleeding volume, operative time, hospitalization time, incision length, and pain score in the DMIP group were significantly less than or shorter than or lower than those in the UNE group (P<0.001). ConclusionThere is no significant difference in the efficacy between the DMIP and UNE in the treatment of PHPT, but DMIP can significantly shorten the operative time and hospitalization time, and reduce the trauma.
Objective To investigate the clinical value on application of endoscopic parathyroiddectomy by gasless unilateral axillary approach, and perioperation management of patients. Methods Twenty-four patients with primary hyperparathyroidism were enrolled and were divided into open group (14 patients underwent open parathyroid surgery) and lumpectomy group (10 patients underwent endoscopic thyroidectomy by gasless unilateral axillary approach) according to the surgical method. All patients received the “5A” model management. The indexes related with perioperative conditions, postoperative incisional pain, and anterior cervical function were compared between the two groups. Results In the open group, 1 patient suffered from transient hoarseness after operation, 5 patients suffered from hypocalcemia on the first day after operation, and 6 patients suffered from temporary hypoparathyroidism. In the lumpectomy group, hypocalcemia occurred in 3 cases and temporary hypoparathyroidism occurred in 3 cases. There were no incision hematoma and infection cases occurred. There was no significant difference between the two groups in the incidence of hypocalcemia and the incidence of temporary hypoparathyroidism after operation (P>0.05). There was no case of incisional hematoma and infection, incisional pain, coughing and sputum excretion or painful swallowing with pain ≥3 in either group. The swallowing disorder index on postoperative day 3 and at 6 months, the scar assessment score and cosmetic satisfaction score at 6 months were higher in the open group than those in the lumpectomy group (P<0.05). Conclusion Patients underwent parathyroidectomy by gasless unilateral axillary approach have the advantages of good cosmetic results and preservation of the function of the anterior cervical region while safely removing the lesion.
ObjectiveTo compare the efficacy of subtotal parathyroidectomy(sPTX) and total parathyroidectomy (tPTX) plus parathyroid autotransplantation(AT) in treatment of secondary hyperparathyroidism(SHPT). MethodsClinical 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). ResultsOf 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). ConclusiontPTX+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.
Objective To investigate the clinical diagnosis and treatment for primary hyperparathyroidism with concomitant thyroid diseases. Methods The clinical data of 40 cases diagnosed as primary hyperparathyroidism with concomitant thyroid diseases including manifestation, preoperative qualitation and localization, and surgical treatment and results were retrospectively analyzed. Results The 40 cases were composed of 4 parathyroid adenomas with thyroid papillary carcinomas, 28 parathyroid adenomas with nodular goiters, 6 parathyroid adenomas with thyroid adenomas, 1 parathyroid hyperplasia with nodular goiter, and 1 parathyroid carcinoma with thyroid adenoma. The diagnostic sensitivities of localization for primary hyperparathyroidism with concomitant thyroid diseases by ultrasound, by computerized tomography (CT), and by radioisotope (99Tcm) scanning were 82.5% (33/40), 80.0% (32/40) and 90.0% (36/40), respectively, and the combined sensitivity was 97.5% (39/40). The surgical treatments included resection of parathyroid adenoma with subtotal thyroidectomy in 34 cases, resection of parathyroid adenoma with total thyroidectomy in 3 cases, bilateral exploration of parathyroid with subtotal thyroidectomy in 1 case, and unilateral parathyroidectomy with thyroidectomy and neck lymphonodes clearance in 2 cases. ConclusionFor primary hyperparathyroidism with concomitant thyroid diseases, the sensitivity of preoperative localization could be raised by combining ultrasound, CT with radioisotope scanning, and surgical resection is the main treatment, which includes the main operation of resection of parathyroid adenoma with subtotal or total thyroidectomy.
Objective To summary the experience in diagnosis and managements for primary hyperparathyroidism（PHPT）. Methods The clinical data of 73 patients with PHPT who underwent parathyroidectomy in our hospital from Jan. 2003 to Dec. 2010 were analyzed retrospectively. Results There were 1 case of hyperplasia （1.4%）， 67 cases of adenoma （91.8%）， and 5 cases of adenocarcinoma （6.8%） among the 73 cases of PHPT. The common presentations involved with pain in bones and joints in 63 cases （86.3%）， pathologic fractures in 17 cases （23.3%）， osteoporosis in 59 cases （80.8%）， fatigue in 28 cases （38.4%）， abdominal pain in 4 cases （5.5%）， urolithiasis in 17 cases （23.3%）， malignant hypertension in 1 case （1.4%） who suffered multi-endocrine neoplasm （MEN）Ⅱa， and so on. The preoperativeserum parathyroid hormone （PTH） abnormally elevated in all 73 patients， and serum calcium abnormally elevated in 59 patients （80.8%）， and alkaline phosphatase abnormally elevated in 62 patients （84.9%） before operation. The positive rate of lesion locations by ultrasonography， CT， 99Tcm-sestamibi （MIBI） scan， and the combination of 3 kinds of tests were 82.8% （53/64）， 83.3% （20/24）， 90.2% （46/51）， and 91.8% （67/73） respectively， but 6 cases were not traced preop-eratively. Parathyroidectomy was conducted to all the cases， besides， regional neck lymphadenectomy was performed for those 5 adenocarcinoma cases. Tetany in 16 cases， hoarseness in 2 cases， acute pancreatitis in 1 case， acute left heart failure in 1 case were observed after operation. Sixty nine cases were follow-up for 3-72 months （average 17.3 months）. During the followed-up period， most of them were alleviated from bone pain （43 cases） and fatigue （18 cases）within 1 month. However， the recovery of PTH and serum calcium back to normality were relatively slow. One case ofadenoma recurred， 1 case of adenocarcinoma suffered lung metastasis， 1 case of adenocarcinoma survived for 37 monthsprior to death for postoperative lung and bone metastasis， the other cases （including 1 case of adenocarcinoma developed from adenoma） were still alive and had no metastasis or recurrence by the end of follow-up. Conclusions The symptoms of PHPT vary and lack of specificity， hence， the enhancement of knowledge to this disease and screenings conducted for parathyroid function and serum calcium will increase the rate of diagnosis. Parathyroidectomy is the effective management for PHPT， and preoperatively accurate position contribute to minimal exploration.
ObjectiveTo explore therapeutic efficacy of parathyroidectomy (PTX) in treatment of secondary hyperparathyroidism (SHPT) in patients with end-stage renal disease.MethodsThe clinical data of 50 patients who underwent PTX for uremic SHPT from January 2016 to March 2018 were collected retrospectively. The changes of serum calcium, phosphorus, and intact parathyroid hormone (iPTH) before the surgery and 1 d, 7 d, 1 month, 3 months and 12 months after the surgery were analyzed. In addition, the improvement of clinical symptoms together with the postoperative recurrence and complications were observed.ResultsTen patients underwent the subtotal PTX (SPTX), 5 cases underwent the total PTX (TPTX), and 35 cases underwent the TPTX with autotransplantation (TPTX+AT). The PTXs were performed successfully in 47/50 (94.0%) patients. After the PTX, the bone pain and skin itching were alleviated, 3 cases had the temporary injury of recurrent laryngeal nerve and the hypoparathyroidism was found in 1 case. The levels of postoperative serum iPTH, calcemia, and phosphorus were lower than those at the preoperative level, the differences were statistically significant (P<0.050). The postoperative hypocalcemia was frequently seen in 38/50 (76.0%) patients, and it was effectively controlled by the intravenous calcium. After the follow-up for 3 months, the SHPT recurred in 5 cases (10.0%), of whom 3 cases underwent the TPTX+AT. The relapse rate in 12 months after the operation was 9.1% (2/22). There were no statistical differences among the three PTXs methods in the operation successful rate (χ2=3.351, P=0.211) and relapse rates in 3 months (χ2=1.321, P=0.753) and 12 months (χ2=1.794, P=0.411) after the operation.ConclusionsIn China, TPTX+AT is more common than SPTX and TPTX in clinical application. Operations of SPTX, TPTX, and TPTX+AT are safe and effective therapeutic methods for uremic SHPT, which can significantly improve biochemical indicators and quality of life of patients.