Therapeutic efficacy evaluation of parathyroidectomy for 50 patients with uremic secondary hyperparathyroidism_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DUAN Menglian , CHEN Chuang ,  SUN Shengrong

Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, P. R. China;

Corresponding author：

SUN Shengrong, Email: sun137@sina.com

Keywords：

uremia; secondary hyperparathyroidism; parathyroidectomy; relapse; hypocalcemia

DOI：

10.7507/1007-9424.201808063

Video：

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Objective To explore therapeutic efficacy of parathyroidectomy (PTX) in treatment of secondary hyperparathyroidism (SHPT) in patients with end-stage renal disease.Methods The 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.Results Ten 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.Conclusions In 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.

Citation： DUAN Menglian, CHEN Chuang, SUN Shengrong. Therapeutic efficacy evaluation of parathyroidectomy for 50 patients with uremic secondary hyperparathyroidism. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(1): 61-66. doi: 10.7507/1007-9424.201808063 Copy

1.	赵文燕, 张凌, 谢亚平, 等. 甲状旁腺切除术改善继发性甲状旁腺功能亢进症维持性血液透析患者生活质量. 中国血液净化, 2011, 10(5): 250-253.
2.	Marx S, Spiegel AM, Skarulis MC, et al. Multiple endocrine neoplasia type 1: clinical and genetic topics. Ann Intern Med, 1998, 129(6): 484-494.
3.	Triponez F, Clark OH, Vanrenthergem Y, et al. Surgical treatment of persistent hyperparathyroidism after renal transplantation. Ann Surg, 2008, 248(1): 18-30.
4.	Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl, 2009, (113): S1-130.
5.	王莉, 李贵森, 刘志红. 中华医学会肾脏病学分会《慢性肾脏病矿物质和骨异常诊治指导》. 肾脏病与透析肾移植杂志, 2013, 22(6): 554-559.
6.	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. Int J Surg, 2017, 44: 353-362.
7.	Lokey J, Pattou F, Mondragon-Sanchez A, et al. Intraoperative decay profile of intact (1-84) parathyroid hormone in surgery for renal hyperparathyroidism—a consecutive series of 80 patients. Surgery, 2000, 128(6): 1029-1034.
8.	Dralle H. Operative treatment of renal autonomous hyperparathyroidism: causes for persistent or recurrent disease in 304 patients (comments on C. Dotzenrath et al.). Langenbecks Arch Surg, 2003, 387(9-10): 392-394.
9.	Zou Q, Wang HY, Zhou J, et al. Total parathyroidectomy combined with partial auto-transplantation for the treatment of secondary hyperparathyroidism. Chin Med J (Engl), 2007, 120(20): 1777-1782.
10.	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. 中国血液净化, 2009, 9(8): 431-436.
11.	邙建波, 刘新杰, 麦沛成. 甲状旁腺次全切除术治疗肾衰继发甲状旁腺功能亢进(附 37 例). 山西医科大学学报, 2010, 41(1): 66-68, 84.
12.	汤兵, 宋宗纬, 侯大卫, 等. 62 例次继发性甲状旁腺功能亢进症行甲状旁腺切除术的临床分析. 中国血液净化, 2012, 11(7): 374-378.
13.	张树军, 王长友, 杨树兴, 等. 不同手术方式治疗继发性甲状旁腺功能亢进对肾性贫血的疗效观察. 临床和实验医学杂志, 2014, 13(3): 197-201.
14.	刘东, 高卓, 魏学明, 等. 甲状旁腺切除治疗尿毒症继发性甲状旁腺功能亢进症患者皮肤瘙痒的临床观察. 中国血液净化, 2014, 13(3): 134-136.
15.	刘占肖, 杨松涛, 张凌, 等. 难治性继发性甲状旁腺功能亢进症患者病理结果临床分析. 中国血液净化, 2014, 13(9): 613-616.
16.	张建荣, 耿燕秋, 张承英, 等. 70 例尿毒症继发性甲状旁腺亢进症行甲状旁腺全切术的疗效分析. 中国血液净化, 2014, 13(9): 617-619.
17.	薛玉仿, 郝丽, 王德光, 等. 甲状旁腺全切并自体前臂移植术治疗肾性难治性继发性甲状旁腺功能亢进疗效随访分析. 临床肾脏病杂志, 2015, 15(4): 212-216.
18.	李屾森, 毛建萍, 王梦婧, 等. 甲状旁腺切除术对尿毒症血液透析患者血磷及骨代谢的影响. 中国血液净化, 2015, 14(5): 256-260.
19.	黄翠霞, 李超. 继发性甲状旁腺功能亢进症行甲状旁腺全部切除术+部分移植术临床效果分析. 白求恩医学杂志, 2015, 13(3): 295-296.
20.	孙海勇, 王田田, 李洪跃, 等. 慢性肾功能衰竭患者继发性甲状旁腺功能亢进的外科治疗. 肾脏病与透析肾移植杂志, 2015, 24(4): 337-341.
21.	赵文燕, 魏文京, 王嘉兴, 等. 甲状旁腺全切术治疗尿毒症继发性甲状旁腺功能亢进的疗效观察. 临床医药实践, 2015, 24(11): 819-822.
22.	张峰, 赵龙珠, 焦小杰, 等. 尿毒症继发甲状旁腺功能亢进症 67 例手术治疗体会. 武警医学, 2016, 27(1): 65-67.
23.	江瑶, 查小明, 邢昌赢, 等. 496 例继发性甲状旁腺功能亢进并甲状旁腺切除术患者的临床特点. 中华肾脏病杂志, 2016, 32(8): 592-597.
24.	王海峰, 张凌, 姚力, 等. 三种不同甲状旁腺切除术治疗继发性甲状旁腺功能亢进 425 例疗效比较. 中国血液净化, 2016, 15(9): 455-458.
25.	周春柳, 程达, 陈民香, 等. 手术治疗难治性继发性甲状旁腺功能亢进 30 例临床疗效分析. 右江民族医学院学报, 2016, 38(5): 496-497.
26.	于婵媛, 杨立志, 窦海川, 等. 不同外科术式治疗尿毒症继发性甲状旁腺功能亢进的效果分析. 中国血液净化, 2017, 16(1): 44-47.
27.	梁伟, 李朋, 陈丽, 等. 手术治疗透析患者继发性甲状旁腺功能亢进症的临床疗效—附 45 例分析. 新医学, 2017, 48(2): 128-131.
28.	陈超, 尹乐平, 冯超, 等. 继发性甲状旁腺功能亢进症的外科治疗效果. 齐鲁医学杂志, 2017, 32(1): 95-97.
29.	李卫东, 张凌, 姚力, 等. 难治性 SHPT 患者行 PTX 的短期和长期疗效观察. 东南大学学报(医学版), 2017, 36(2): 221-224.
30.	鲁瑶, 孙小亮, 张凌, 等. 甲状旁腺全切除治疗继发性甲状旁腺功能亢进. 中日友好医院学报, 2017, 31(2): 79-81.
31.	王玉芹, 葛益飞, 毛慧娟. 继发性甲状旁腺功能亢进症 57 例手术治疗临床分析. 重庆医学, 2017, 46(18): 2478-2480.
32.	高恒元, 许楠, 林俊清, 等. 甲状旁腺全切除与次全切除术治疗尿毒症继发性甲状旁腺功能亢进的疗效分析. 慢性病学杂志, 2017, 18(8): 871-873.
33.	贾英韬, 路丽. 甲状旁腺切除术治疗尿毒症患者难治性甲状旁腺功能亢进症 30 例疗效评价. 山西医药杂志, 2017, 46(17): 2109-2111.
34.	Kirushnan BB, Rao BS, Annigeri R, et al. Impact of malnutrition, inflammation, and atherosclerosis on the outcome in hemodialysis patients. Indian J Nephrol, 2017, 27(4): 277-283.
35.	Clinical practice guidelines for nutrition in chronic renal failure. K/DOQI, National Kidney Foundation. Am J Kidney Dis, 2000, 35(6 Suppl 2): S1-S140.
36.	Chen J, Jia X, Kong X, et al. Total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy for renal hyperparathyroidism: A systematic review and meta-analysis. Nephrology (Carlton), 2017, 22(5): 388-396.
37.	Schneider R, Slater EP, Karakas E, et al. Initial parathyroid surgery in 606 patients with renal hyperparathyroidism. World J Surg, 2012, 36(2): 318-326.
38.	Schlosser K, Veit JA, Witte S, et al. Comparison of total parathyroidectomy without autotransplantation and without thymectomy versus total parathyroidectomy with autotransplantation and with thymectomy for secondary hyperparathyroidism: TOPAR PILOT-Trial. Trials, 2007, 8: 22.
39.	Wirowski D, Goretzki PE, Schwarz K, et al. Failed surgery in primary hyperparathyroidism—what has changed with time. Exp Clin Endocrinol Diabetes, 2013, 121(6): 323-328.
40.	Tsai WC, Peng YS, Chiu YL, et al. Risk factors for severe hypocalcemia after parathyroidectomy in prevalent dialysis patients with secondary hyperparathyroidism. Int Urol Nephrol, 2015, 47(7): 1203-1207.

1. 赵文燕, 张凌, 谢亚平, 等. 甲状旁腺切除术改善继发性甲状旁腺功能亢进症维持性血液透析患者生活质量. 中国血液净化, 2011, 10(5): 250-253.
2. Marx S, Spiegel AM, Skarulis MC, et al. Multiple endocrine neoplasia type 1: clinical and genetic topics. Ann Intern Med, 1998, 129(6): 484-494.
3. Triponez F, Clark OH, Vanrenthergem Y, et al. Surgical treatment of persistent hyperparathyroidism after renal transplantation. Ann Surg, 2008, 248(1): 18-30.
4. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl, 2009, (113): S1-130.
5. 王莉, 李贵森, 刘志红. 中华医学会肾脏病学分会《慢性肾脏病矿物质和骨异常诊治指导》. 肾脏病与透析肾移植杂志, 2013, 22(6): 554-559.
6. 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. Int J Surg, 2017, 44: 353-362.
7. Lokey J, Pattou F, Mondragon-Sanchez A, et al. Intraoperative decay profile of intact (1-84) parathyroid hormone in surgery for renal hyperparathyroidism—a consecutive series of 80 patients. Surgery, 2000, 128(6): 1029-1034.
8. Dralle H. Operative treatment of renal autonomous hyperparathyroidism: causes for persistent or recurrent disease in 304 patients (comments on C. Dotzenrath et al.). Langenbecks Arch Surg, 2003, 387(9-10): 392-394.
9. Zou Q, Wang HY, Zhou J, et al. Total parathyroidectomy combined with partial auto-transplantation for the treatment of secondary hyperparathyroidism. Chin Med J (Engl), 2007, 120(20): 1777-1782.
10. 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. 中国血液净化, 2009, 9(8): 431-436.
11. 邙建波, 刘新杰, 麦沛成. 甲状旁腺次全切除术治疗肾衰继发甲状旁腺功能亢进(附 37 例). 山西医科大学学报, 2010, 41(1): 66-68, 84.
12. 汤兵, 宋宗纬, 侯大卫, 等. 62 例次继发性甲状旁腺功能亢进症行甲状旁腺切除术的临床分析. 中国血液净化, 2012, 11(7): 374-378.
13. 张树军, 王长友, 杨树兴, 等. 不同手术方式治疗继发性甲状旁腺功能亢进对肾性贫血的疗效观察. 临床和实验医学杂志, 2014, 13(3): 197-201.
14. 刘东, 高卓, 魏学明, 等. 甲状旁腺切除治疗尿毒症继发性甲状旁腺功能亢进症患者皮肤瘙痒的临床观察. 中国血液净化, 2014, 13(3): 134-136.
15. 刘占肖, 杨松涛, 张凌, 等. 难治性继发性甲状旁腺功能亢进症患者病理结果临床分析. 中国血液净化, 2014, 13(9): 613-616.
16. 张建荣, 耿燕秋, 张承英, 等. 70 例尿毒症继发性甲状旁腺亢进症行甲状旁腺全切术的疗效分析. 中国血液净化, 2014, 13(9): 617-619.
17. 薛玉仿, 郝丽, 王德光, 等. 甲状旁腺全切并自体前臂移植术治疗肾性难治性继发性甲状旁腺功能亢进疗效随访分析. 临床肾脏病杂志, 2015, 15(4): 212-216.
18. 李屾森, 毛建萍, 王梦婧, 等. 甲状旁腺切除术对尿毒症血液透析患者血磷及骨代谢的影响. 中国血液净化, 2015, 14(5): 256-260.
19. 黄翠霞, 李超. 继发性甲状旁腺功能亢进症行甲状旁腺全部切除术+部分移植术临床效果分析. 白求恩医学杂志, 2015, 13(3): 295-296.
20. 孙海勇, 王田田, 李洪跃, 等. 慢性肾功能衰竭患者继发性甲状旁腺功能亢进的外科治疗. 肾脏病与透析肾移植杂志, 2015, 24(4): 337-341.
21. 赵文燕, 魏文京, 王嘉兴, 等. 甲状旁腺全切术治疗尿毒症继发性甲状旁腺功能亢进的疗效观察. 临床医药实践, 2015, 24(11): 819-822.
22. 张峰, 赵龙珠, 焦小杰, 等. 尿毒症继发甲状旁腺功能亢进症 67 例手术治疗体会. 武警医学, 2016, 27(1): 65-67.
23. 江瑶, 查小明, 邢昌赢, 等. 496 例继发性甲状旁腺功能亢进并甲状旁腺切除术患者的临床特点. 中华肾脏病杂志, 2016, 32(8): 592-597.
24. 王海峰, 张凌, 姚力, 等. 三种不同甲状旁腺切除术治疗继发性甲状旁腺功能亢进 425 例疗效比较. 中国血液净化, 2016, 15(9): 455-458.
25. 周春柳, 程达, 陈民香, 等. 手术治疗难治性继发性甲状旁腺功能亢进 30 例临床疗效分析. 右江民族医学院学报, 2016, 38(5): 496-497.
26. 于婵媛, 杨立志, 窦海川, 等. 不同外科术式治疗尿毒症继发性甲状旁腺功能亢进的效果分析. 中国血液净化, 2017, 16(1): 44-47.
27. 梁伟, 李朋, 陈丽, 等. 手术治疗透析患者继发性甲状旁腺功能亢进症的临床疗效—附 45 例分析. 新医学, 2017, 48(2): 128-131.
28. 陈超, 尹乐平, 冯超, 等. 继发性甲状旁腺功能亢进症的外科治疗效果. 齐鲁医学杂志, 2017, 32(1): 95-97.
29. 李卫东, 张凌, 姚力, 等. 难治性 SHPT 患者行 PTX 的短期和长期疗效观察. 东南大学学报(医学版), 2017, 36(2): 221-224.
30. 鲁瑶, 孙小亮, 张凌, 等. 甲状旁腺全切除治疗继发性甲状旁腺功能亢进. 中日友好医院学报, 2017, 31(2): 79-81.
31. 王玉芹, 葛益飞, 毛慧娟. 继发性甲状旁腺功能亢进症 57 例手术治疗临床分析. 重庆医学, 2017, 46(18): 2478-2480.
32. 高恒元, 许楠, 林俊清, 等. 甲状旁腺全切除与次全切除术治疗尿毒症继发性甲状旁腺功能亢进的疗效分析. 慢性病学杂志, 2017, 18(8): 871-873.
33. 贾英韬, 路丽. 甲状旁腺切除术治疗尿毒症患者难治性甲状旁腺功能亢进症 30 例疗效评价. 山西医药杂志, 2017, 46(17): 2109-2111.
34. Kirushnan BB, Rao BS, Annigeri R, et al. Impact of malnutrition, inflammation, and atherosclerosis on the outcome in hemodialysis patients. Indian J Nephrol, 2017, 27(4): 277-283.
35. Clinical practice guidelines for nutrition in chronic renal failure. K/DOQI, National Kidney Foundation. Am J Kidney Dis, 2000, 35(6 Suppl 2): S1-S140.
36. Chen J, Jia X, Kong X, et al. Total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy for renal hyperparathyroidism: A systematic review and meta-analysis. Nephrology (Carlton), 2017, 22(5): 388-396.
37. Schneider R, Slater EP, Karakas E, et al. Initial parathyroid surgery in 606 patients with renal hyperparathyroidism. World J Surg, 2012, 36(2): 318-326.
38. Schlosser K, Veit JA, Witte S, et al. Comparison of total parathyroidectomy without autotransplantation and without thymectomy versus total parathyroidectomy with autotransplantation and with thymectomy for secondary hyperparathyroidism: TOPAR PILOT-Trial. Trials, 2007, 8: 22.
39. Wirowski D, Goretzki PE, Schwarz K, et al. Failed surgery in primary hyperparathyroidism—what has changed with time. Exp Clin Endocrinol Diabetes, 2013, 121(6): 323-328.
40. Tsai WC, Peng YS, Chiu YL, et al. Risk factors for severe hypocalcemia after parathyroidectomy in prevalent dialysis patients with secondary hyperparathyroidism. Int Urol Nephrol, 2015, 47(7): 1203-1207.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Therapeutic efficacy evaluation of parathyroidectomy for 50 patients with uremic secondary hyperparathyroidism

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