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,張凌.繼發性甲狀旁腺功能亢進的外科治療[J].臨床內科雜志, 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.	張建榮,張凌.慢性腎臟病繼發性甲旁亢[M].北京:人民軍醫出版社, 2010:143-145.
7.	劉君,王家東.甲狀旁腺切除術治療繼發性甲狀旁腺功能亢進[J].中國耳鼻咽喉頭頸外科, 2005, 12(7):427-429.
8.	王金,徐祗順,姜光洲,等.原發性甲狀旁腺功能亢進癥20例[J].中國現代普通外科進展, 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.	張凌,王文博.繼發性甲狀旁腺功能亢進癥的不同甲狀旁腺切除術式治療[J].中國血液凈化, 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,顧勇,薛駿,等.甲狀旁腺全切除加前臂移植治療尿毒癥繼發性甲狀旁腺功能亢進[J].中華腎臟病雜志, 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,張凌,劉鵬,等.甲狀旁腺切除術治療難治性甲狀旁腺功能亢進癥89例療效評價[J].中國血液凈化, 2009, 8(8):431-436.
16.	張媛元,鄭塵飛,孫文學,等.尿毒癥繼發性甲狀旁腺亢進兩種手術方式的療效比較[J].中國中西醫結合腎病雜志, 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.	鄧如崗,王志明,呂新生,等.結節性甲狀腺腫的外科治療[J].中國普通外科雜志, 2004, 13(5):343-345.

1. ?花瞻,姚力,張凌.繼發性甲狀旁腺功能亢進的外科治療[J].臨床內科雜志, 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. 張建榮,張凌.慢性腎臟病繼發性甲旁亢[M].北京:人民軍醫出版社, 2010:143-145.
7. 劉君,王家東.甲狀旁腺切除術治療繼發性甲狀旁腺功能亢進[J].中國耳鼻咽喉頭頸外科, 2005, 12(7):427-429.
8. 王金,徐祗順,姜光洲,等.原發性甲狀旁腺功能亢進癥20例[J].中國現代普通外科進展, 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. 張凌,王文博.繼發性甲狀旁腺功能亢進癥的不同甲狀旁腺切除術式治療[J].中國血液凈化, 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,顧勇,薛駿,等.甲狀旁腺全切除加前臂移植治療尿毒癥繼發性甲狀旁腺功能亢進[J].中華腎臟病雜志, 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,張凌,劉鵬,等.甲狀旁腺切除術治療難治性甲狀旁腺功能亢進癥89例療效評價[J].中國血液凈化, 2009, 8(8):431-436.
16. 張媛元,鄭塵飛,孫文學,等.尿毒癥繼發性甲狀旁腺亢進兩種手術方式的療效比較[J].中國中西醫結合腎病雜志, 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. 鄧如崗,王志明,呂新生,等.結節性甲狀腺腫的外科治療[J].中國普通外科雜志, 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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