Effect of γ-detector guided total parathyroidectomy and auto transplantation in treatment of secondary hyperparathyroidism_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHU Yuxiang ¹ , MOU Hongbin ² ,  LI Chunlian ¹ , WANG Chengcheng ¹ , ZHANG Jiaxin ¹

1. Department of Thyroid and Breast Surgery, Northern Jiangsu Province People’s Hospital, Yangzhou, Jiangsu 225001, P. R. China;
2. Department of Nephrology, Northern Jiangsu Province People’s Hospital, Yangzhou, Jiangsu 225001, P. R. China;

Corresponding?author：

LI Chunlian, Email: chunlianlccl@163.com

Keywords：

secondary hyperparathyroidism; gamma detector; total parathyroidectomy; auto transplantation; effect

DOI：

10.7507/1007-9424.202109002

Video：

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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.

Citation： ZHU Yuxiang, MOU Hongbin, LI Chunlian, WANG Chengcheng, ZHANG Jiaxin. Effect of γ-detector guided total parathyroidectomy and auto transplantation in treatment of secondary hyperparathyroidism. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(7): 933-938. doi: 10.7507/1007-9424.202109002 Copy

1.	Komaba H, Taniguchi M, Wada A, et al. Parathyroidectomy and survival among Japanese hemodialysis patients with secondary hyperparathyroidism. Kidney Int, 2015, 88(2): 350-359.
2.	Yamamoto S, Fukagawa M. Uremic toxicity and bone in CKD. J Nephrol, 2017, 30(5): 623-627.
3.	Zhang Y, Zhang DZ. Circulating parathyroid hormone and risk of hypertension: a meta-analysis. Clin Chim Acta, 2018, 482: 40-45.
4.	張洪彬, 趙寒輝, 王素霞, 等. 繼發性甲狀旁腺功能亢進的發病機制和診治. 臨床腎臟病雜志, 2021, 21(11): 950-955.
5.	張凌. 繼發性甲狀旁腺功能亢進的治療策略. 中華腎病研究電子雜志, 2015, 4(3): 118-122.
6.	王海峰, 張凌, 姚力. 三種不同甲狀旁腺切除術治療繼發性甲狀旁腺功能亢進425例療效比較. 中國血液凈化, 2016, 15(9): 455-458.
7.	王紅鷹, 黃駿文, 鄒強, 等. 甲狀旁腺全切除加前臂自體移植術治療腎性繼發性甲狀旁腺功能亢進的長期療效. 外科理論與實踐, 2018, 23(6): 523-527.
8.	Xue J, Liu Y, Ji T, et al. Comparison between technetium-99m methoxyisobutylisonitrile scintigraphy and ultrasound in the diagnosis of parathyroid adenoma and parathyroid hyperplasia. Nucl Med Commun, 2018, 39(12): 1129-1137.
9.	喬楠, 付慶鋒, 李鴻博, 等. 繼發性甲狀旁腺功能亢進外科治療中甲狀旁腺自體移植現狀. 中國實用外科雜志, 2019, 39(4): 379-381.
10.	中國醫師協會外科醫師分會甲狀腺外科醫師委員會, 中國研究型醫院學會甲狀腺疾病專業委員會. 慢性腎功能衰竭繼發甲狀旁腺功能亢進外科臨床實踐專家共識. 中國實用外科雜志, 2016, 36(5): 481-486.
11.	Mehrabibahar M, Mousavi Z, Sadeghi R, et al. Feasibility and safety of minimally invasive radioguided parathyroidectomy using very low intraoperative dose of Tc-99m MIBI. Int J Surg, 2017, 39: 229-233.
12.	劉巖, 王岐, 楊路路, 等. ⁹⁹Tc^m-MIBI雙時相顯像對甲狀旁腺腺瘤和甲狀旁腺增生的診斷價值. 中國普外基礎與臨床雜志, 2021, 28(11): 1457-1461.
13.	張峻嘉, 邊學海. 甲狀旁腺術中識別方法的進展與探討. 中國普通外科雜志, 2018, 27(5): 629-634.
14.	陳安舉, 王田田, 薄少軍, 等. 術中甲狀旁腺激素測定在繼發性甲狀旁腺功能亢進手術中的臨床應用價值. 臨床耳鼻咽喉頭頸外科雜志, 2019, 33(12): 1168-1172.
15.	胡茂飛, 劉慶, 高新春, 等. 難治性SHPT治療新理念: 甲狀旁腺肅清手術. 中國現代普通外科進展, 2018, 21(8): 623-627.
16.	吳承倢, 盧春燕. 術后骨饑餓綜合征. 中國普外基礎與臨床雜志, 2021, 28(2): 265-270.
17.	Chou FF, Chi SY, Hsieh KC. Hypoparathyroidism after total parathyroidectomy plus subcutaneous autotransplantation for secondary hyperparathyroidism－any side effects? World J Surg, 2010, 34(10): 2350-2354.
18.	Yuan F, Yu W, Waqas A, et al. Radioactive probe-guided parathyroidectomy for secondary hyperparathyroidism. Chin Med J (Engl), 2014, 127(13): 2413-2418.
19.	Li C, Lv L, Wang H, et al. Total parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: systematic review and meta-analysis. Ren Fail, 2017, 39(1): 678-687.
20.	汪燕, 周莉, 付平. 手術治療繼發性甲狀旁腺功能亢進多學科協作中的內科管理. 華西醫學, 2019, 34(7): 759-763.

1. Komaba H, Taniguchi M, Wada A, et al. Parathyroidectomy and survival among Japanese hemodialysis patients with secondary hyperparathyroidism. Kidney Int, 2015, 88(2): 350-359.
2. Yamamoto S, Fukagawa M. Uremic toxicity and bone in CKD. J Nephrol, 2017, 30(5): 623-627.
3. Zhang Y, Zhang DZ. Circulating parathyroid hormone and risk of hypertension: a meta-analysis. Clin Chim Acta, 2018, 482: 40-45.
4. 張洪彬, 趙寒輝, 王素霞, 等. 繼發性甲狀旁腺功能亢進的發病機制和診治. 臨床腎臟病雜志, 2021, 21(11): 950-955.
5. 張凌. 繼發性甲狀旁腺功能亢進的治療策略. 中華腎病研究電子雜志, 2015, 4(3): 118-122.
6. 王海峰, 張凌, 姚力. 三種不同甲狀旁腺切除術治療繼發性甲狀旁腺功能亢進425例療效比較. 中國血液凈化, 2016, 15(9): 455-458.
7. 王紅鷹, 黃駿文, 鄒強, 等. 甲狀旁腺全切除加前臂自體移植術治療腎性繼發性甲狀旁腺功能亢進的長期療效. 外科理論與實踐, 2018, 23(6): 523-527.
8. Xue J, Liu Y, Ji T, et al. Comparison between technetium-99m methoxyisobutylisonitrile scintigraphy and ultrasound in the diagnosis of parathyroid adenoma and parathyroid hyperplasia. Nucl Med Commun, 2018, 39(12): 1129-1137.
9. 喬楠, 付慶鋒, 李鴻博, 等. 繼發性甲狀旁腺功能亢進外科治療中甲狀旁腺自體移植現狀. 中國實用外科雜志, 2019, 39(4): 379-381.
10. 中國醫師協會外科醫師分會甲狀腺外科醫師委員會, 中國研究型醫院學會甲狀腺疾病專業委員會. 慢性腎功能衰竭繼發甲狀旁腺功能亢進外科臨床實踐專家共識. 中國實用外科雜志, 2016, 36(5): 481-486.
11. Mehrabibahar M, Mousavi Z, Sadeghi R, et al. Feasibility and safety of minimally invasive radioguided parathyroidectomy using very low intraoperative dose of Tc-99m MIBI. Int J Surg, 2017, 39: 229-233.
12. 劉巖, 王岐, 楊路路, 等. ⁹⁹Tc^m-MIBI雙時相顯像對甲狀旁腺腺瘤和甲狀旁腺增生的診斷價值. 中國普外基礎與臨床雜志, 2021, 28(11): 1457-1461.
13. 張峻嘉, 邊學海. 甲狀旁腺術中識別方法的進展與探討. 中國普通外科雜志, 2018, 27(5): 629-634.
14. 陳安舉, 王田田, 薄少軍, 等. 術中甲狀旁腺激素測定在繼發性甲狀旁腺功能亢進手術中的臨床應用價值. 臨床耳鼻咽喉頭頸外科雜志, 2019, 33(12): 1168-1172.
15. 胡茂飛, 劉慶, 高新春, 等. 難治性SHPT治療新理念: 甲狀旁腺肅清手術. 中國現代普通外科進展, 2018, 21(8): 623-627.
16. 吳承倢, 盧春燕. 術后骨饑餓綜合征. 中國普外基礎與臨床雜志, 2021, 28(2): 265-270.
17. Chou FF, Chi SY, Hsieh KC. Hypoparathyroidism after total parathyroidectomy plus subcutaneous autotransplantation for secondary hyperparathyroidism－any side effects? World J Surg, 2010, 34(10): 2350-2354.
18. Yuan F, Yu W, Waqas A, et al. Radioactive probe-guided parathyroidectomy for secondary hyperparathyroidism. Chin Med J (Engl), 2014, 127(13): 2413-2418.
19. Li C, Lv L, Wang H, et al. Total parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: systematic review and meta-analysis. Ren Fail, 2017, 39(1): 678-687.
20. 汪燕, 周莉, 付平. 手術治療繼發性甲狀旁腺功能亢進多學科協作中的內科管理. 華西醫學, 2019, 34(7): 759-763.

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Effect of γ-detector guided total parathyroidectomy and auto transplantation in treatment of secondary hyperparathyroidism

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