Objective To compare the results after purge parathyroidectomy (PPTX) and traditional approaches performed for secondary hyperparathyroidism (SHPT). Methods A total of 49 patients with SHPT who underwent parathyroidectomy from January 2010 to November 2017 were retrospectively analyzed. We compared outcomes between PPTX group and traditional parathyroidectomy group including total parathyroidectomy and total parathyroidectomy with autotransplantation. Results There was no difference in the rate of persistent or recurrent SHPT between 2 groups during follow-up (P>0.05). Analysis of the patients with successful surgery revealed that patients in PPTX group had a lower level of intact parathyroid hormone (iPTH) at 6 months postoperatively compared with that in traditional parathyroidectomy group (P=0.013). No significant difference was found between 2 groups in the rate of transient or persistent lower iPTH (P>0.05). Patients in PPTX group required more calcium supplementation(P=0.003), while no difference was present in the extent of hypocalcemia between 2 groups (P>0.05). Conclusions PPTX would be more effective in lowering iPTH. However, the patients need more calcium supplementation to prevent hypocalcemia after PPTX.
LI Wei, LIU Bingyang, SHAN Chenxiang, RAO Wensheng, ZHANG Wei, QIU Ming
. Evaluation of purge parathyroidectomy in treatment of secondary hyperparathyroidism[J]. Journal of Surgery Concepts & Practice, 2019
, 24(04)
: 325
-329
.
DOI: 10.16139/j.1007-9610.2019.04.011
[1] Hanna T, Akoh JA.Total parathyroidectomy in patients with chronic kidney disease: Avoiding repeat surgery[J]. Saudi J Kidney Dis Transpl,2016,27(5):950-957.
[2] Puccini M, Carpi A, Cupisti A, et al.Total parathyroidectomy without autotransplantation for the treatment of secondary hyperparathyroidism associated with chronic kidney disease: clinical and laboratory long-term follow-up[J]. Biomed Pharmacother,2010,64(5):359-362.
[3] Shan CX, Qiu NC, Zha SL, et al.A novel surgical strategy for secondary hyperparathyroidism: Purge parathyroidectomy[J]. Int J Surg,2017,43:112-118.
[4] 中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 慢性肾功能衰竭继发甲状旁腺功能亢进外科临床实践专家共识[J]. 中国实用外科杂志,2016,36(5):481-486.
[5] Anderson KJr, Ruel E, Adam MA, et al.Subtotal vs. total parathyroidectomy with autotransplantation for patients with renal hyperparathyroidism have similar outcomes[J]. Am J Surg,2017,214(5):914-919.
[6] Schlosser K, Bartsch DK, Diener MK, et al.Total parathyroidectomy with routine thymectomy and autotransplantation versus total parathyroidectomy alone for secondary hyperparathyroidism: results of a nonconfirmatory multicenter prospective randomized controlled pilot trial[J]. Ann Surg,2016,264(5):745-753.
[7] Liu ME, Qiu NC, Zha SL, et al.To assess the effects of parathyroidectomy(TPTX versus TPTX+AT) for secondary hyperparathyroidism in chronic renal failure: a systematic review and meta-analysis[J]. Int J Surg,2017,44:353-362.
[8] Coulston JE, Egan R, Willis E, et al.Total parathyroidectomy without autotransplantation for renal hyperparathyroidism[J]. Br J Surg,2010,97(11):1674-1679.
[9] Boyd JD.Development of the thyroid and parathyroid glands and the thymus[J]. Ann R Coll Surg Engl,1950,7(6):455-471.
[10] Okada M, Tominaga Y, Yamamoto T, et al.Location frequency of missed parathyroid glands after parathyroidectomy in patients with persistent or recurrent secondary hyperparathyroidism[J]. World J Surg,2016,40(3):595-599.
[11] Li C, Lv L, Wang H, et al.Total parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: systematic review and meta-analysis[J]. Ren Fail,2017,39(1):678-687.
[12] Fukagawa M, Yokoyama K, Koiwa F, et al.Clinical practice guideline for the management of chronic kidney disease-mineral and bone disorder[J]. Ther Apher Dial,2013, 17(3):247-288.
[13] Barreto FC, Bucharles SGE.Predicting the successfulness of parathyroidectomy: new lessons from an old challenge[J]. J Bras Nefrol,2017,39(2):100-101.
[14] Iwamoto N, Sato N, Nishida M, et al.Low parathyroid hormone levels after parathyroidectomy reduce cardiovascular mortality in chronic hemodialysis patients[J]. Clin Exp Nephrol,2016,20(5):808-814.