ObjectiveTo explore the selection and application value of preoperative stereotactic localization in the surgical treatment of secondary hyperparathyroidism.MethodsThe preoperative ultrasound, CT, and methoxyisobutylisonitrile (MIBI) scan data of 54 patients with secondary hyperparathyroidism confirmed by pathological examination in the Department of General Surgery of the 900th Hospital of the Joint Logistics Team from September 2016 to January 2020 were retrospectively analyzed, to explore the localization accuracy of the three methods alone or in combination.ResultsIn this study, a total of 207 parathyroids were detected, 1 was misdiagnosed (ectopic thymus),9 were missed, and 216 parathyroids were removed. The preoperative localization accuracy of CT, ultrasound, and MIBI was the highest (95.39%, 207/217), followed by ultrasound and MIBI (93.55%, 203/217) and CT+MIBI (89.40%, 194/217), compared with other single or two methods, the differences were statistically significant (P<0.05). The accuracy of CT combined with ultrasound localization (82.49%, 179/217) was slightly higher than that of MIBI scan alone (78.80%, 171/217), but the difference was not statistically significant (P=0.060). Although the location accuracy of MIBI scan was slightly higher than that of ultrasound localization (77.88%, 169/217), the difference was not statistically significant (P=0.084).ConclusionIn order to maximize the accuracy of preoperative stereotactic localization of secondary hyperparathyroidism, ultrasound, CT, and MIBI should be combined.
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 analyze the factors influencing the hungry bone syndrome (HBS) in patients with secondary hyperparathyroidism (SHPT) after parathyroidectomy. MethodsThe clinical data of patients who underwent parathyroidectomy for SHPT in the 900th Hospital of the Joint Logistics Support Force from January 2016 to May 2021 were retrospectively analyzed. The risk factors for HBS were analyzed by binary logistic regression analysis. The cut-off value of risk factors for predicting postoperative HBS was analyzed by using recieve operating characteristic (ROC) curve. ResultsA total of 89 patients were included in this study, including 44 males and 45 females, with (47±11) years old. There were 42 (47.2%) patients with HBS. Compared with the patients without HBS, the patients with HBS was younger and had higher levels of preoperative parathyroid hormone, potassium, and alkaline phosphatase (ALP), the differences were statistically different (P<0.05). The multivariate binary logistic regression analysis showed that the higher preoperative ALP level was a risk factor for the HBS [OR (95%CI) = 1.014 (1.007, 1.020), P<0.001]. The area under the ROC curve (95%CI) of the preoperative ALP level in distinguishing the patients with HBS from without HBS was 0.957 (0.919, 0.996), and the optimal cut-off value of ALP for predicting postoperative HBS was 278.90 U/L. ConclusionsFrom the preliminary results of this study, it can be concluded that bone conversion status can be differentiated according to preoperative ALP level in patients with SHPT. When preoperative ALP level is higher than cut-off value, it is recommended that calcium supplementation should be given as soon as possible and blood calcium level should be closely monitored.