ObjectiveTo explore therapeutic efficacy of parathyroidectomy (PTX) in treatment of secondary hyperparathyroidism (SHPT) in patients with end-stage renal disease.MethodsThe 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.ResultsTen 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.ConclusionsIn 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.
Objective To evaluate the diagnostic significance and to analyze reasons of false negative cases forpreoperative ultrasonography， 99Tcm-sestamibi scintigraphy （MIBI scintigraphy）， and CT in primary hyperparathyroidism（PHPT）. Methods Clinical data of 69 patients with PHPT， who underwent operation in Affiliated Shengjing Hospital of China Medical University between Jan. 2003 and Aug. 2012 were retrospectively analyzed. Results There were 76 parathyroid lesions in 69 PHPT patients proved by operation and pathology， including 58 cases of parathyroid adenoma with 60 lesions， 7 cases of parathyroid hyperplasia with 11 lesions， and 4 cases of parathyroid carcinoma with 5 lesions. The sensitivity of ultrasonography， CT， and 99Tcm-MIBI scintigraphy were 81.94% （59/72）， 61.76% （21/34）， and 69.57% （16/23）， the accuracy of 3 kinds of tests were 78.67% （59/75）， 61.76% （21/34）， and 66.67% （16/24）， the positive predictive value were 95.16% （59/62）， 100% （21/21）， and 94.12% （16/17） respectively. There was significant differ-ence only between ultrasonography and CT in sensitivity （P=0.03）， no other significant difference was found （P＞0.05）.Conclusions Ultrasonography is complementary to 99Tcm-MIBI scintigraphy， but CT has little significance in diagnosis of PHPT. Both of ultrasonography and 99Tcm-MIBI scintigraphy should be used before operation routinely to localize parathyroid lesions.
Objective To summarize the changes of serum vitamin D level in patients with primary hyperparathyroidism (pHPT), the correlation between vitamin D and clinical manifestations, and feasible pathogenesis of pHPT. Method The literatures related to vitamin D and pHPT in recent years were reviewed. Results The level of vitamin D was decreased in patients with pHPT. Vitamin D level was negatively correlated with the weight of parathyroid adenoma, parathyroid hormone and blood calcium level, and positively correlated with bone mineral density. Conclusions Vitamin D nutritional status affects the severity of symptoms, main biochemical indexes and main clinical complications of patients with pHPT. There are various reasons accounted for the decline of vitamin D level, and the specific pathogenesis needs to be further explored. For patients with pHPT, vitamin D should be supplemented carefully and appropriately before surgical operation.
ObjectiveTo investigate the significance of 99Tcm-MIBI SPECT dual-phase imaging, B-ultrasound and CT in the diagnosis of primary hyperparathyroidism, and its relationship with the level of serum calcium (CA).
MethodsThe clinical data of 73 patients with parathyroid dysfunction (serum parathyroid hormone (PTH) > 130 pg/mL) were retrospectively analyzed. The 99Tcm-MIBI SPECT double phase imaging were performed in 73 cases, 63 cases underwent cervical B-ultrasound examination, and 16 cases underwent CT examination. According to the serum calcium (CA) levels, the patients were divided into CA < 2.7 mmol/L group and CA > 2.7 mmol/L group, and the postoperative pathological examination and followed-up results were as the standard, the sensitivity, specificity, positive predictive value, and negative predictive value of 99Tcm-MIBI SPECT dual-phase imaging, B-ultrasound and CT for diagnosis of PHPT in different serum CA levels were compared.
ResultsThe sensitivity of 99Tcm-MIBI SPECT dual-phase imaging, B-ultrasound and CT examination for diagnosis of PHPT was 87.6%, 81.8% and 35.7%, respectively; the specificity was 87.5%, 75.5% and 50.0%, respectively; the positive predictive value was 98.2%, 93.7% and 83.3%, respectively; and the negative predictive value was 46.7%, 33.3% and 10%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of 99Tcm-MIBI SPECT dual-phase imaging and B-ultrasound examination for diagnosis of PHPT were significantly higher than those of CT examination(P < 0.05). The sensitivity, specificity, positive predictive value and negative predictive value of 99Tcm-MIBI SPECT dual-phase imaging for diagnosis of PHPT were higher than those of B-ultrasound examination, but the difference was not statistically significant (P > 0.05). In the CA < 2.7 mmol/L group, the sensitivity of 99Tcm-MIBI SPECT dual-phase imaging, B-ultrasound and CT examination for diagnosis of PHPT was 91.1%, 84.7% and 37.9%, respectively; the specificity was 80.2%, 72.9% and 49.7%, respectively; the positive predictive value was 96.8%, 96.0% and 79.4%, respectively; and the negative predictive value was 50.0%, 37.5% and 10.0%. In the CA > 2.7 mmol/L group, The sensitivity of 99Tcm-MIBI SPECT dual-phase imaging, B-ultrasound and CT examination for diagnosis of PHPT was 87.9%, 83.9% and 42.8%, respectively; the specificity was 83.3%, 79.2% and 50.0%, respectively; the positive predictive value was 96.9%, 94.1% and 75.0%, respectively; and the negative predictive value was 50.0%, 40.5% and 20.0%. There were no significant difference in the diagnostic accuracy between the 3 methods and the level of serum CV in different levels.
ConclusionsThe diagnostic accuracy of 99Tcm-MIBI SPECT dual-phase imaging and B-ultrasound examination for diagnosis of PHPT patients with PTH > 130 pg/mL (especially parathyroid adenoma) were higher than that of CT examination, and it is not associated with the serum CA concentration.
ObjectiveTo analysis the clinical symptoms, diagnosis, and treatment of primary hyperparathyroidism (PHPT).
MethodsA retrospective study was made in consecutive patients with PHPT who performed operation and had integral data between January 2004 to December 2012 in West China Hospital.
ResultsThe 136 cases were composed of 52 cases (38.23%) bone types, 17 cases (12.50%) nephrocalcinosis, 7 cases (5.15%) skeletal and renal involvements, 24 cases (17.65%) asymptomatic primary hyperparathyroidism, and 36 cases (26.47%) combined with other clinical symptoms. The preoperative parathyroid hormone (PTH) levels were (106.20±88.88) pmol/L (6.91-390 pmol/L) and serum calcium were (3.12±0.66) mmol/L (2.15-5.77 mmol/L). The coincidence rate between the examinations preoperation and pathology:B type ultrasound was 75.00%, 99Tcm-MIBI scan was 85.29%, ultrasound and 99Tcm-MIBI combined with computerized tomography (CT) scan was 86.76%. Pathology presentation:129 patients (94.85%) were benign lesions, 7 cases (5.15%) were parathyroid carcinoma. Of the 129 patients, 114 cases (95.80%) were single parathyroid adenoma, 5 cases (4.20%) were multiple parathyroid adenoma or combined parathyroid hyperplasia, 10 cases (7.75%) were parathyroid hyperplasia. Of the patients, the PTH level decreased to below normal upper limit within 3 days after surgery in 124 cases (91.18%). One hundred and twenty-four cases (91.18%) were followed-up. The follow-up time was 6-112 months, a median follow-up time was 49 months. Twelve patients (8.82%) were lost to follow-up, 2 patients (1.47%) with carcinoma recurrence, the rest patients without recurrence and metastasis. Three patients (2.20%) with parathyroid carcinoma died. Of the 3 patients, 2 died of systemic metastasis of parathyroid carcinoma in 18 and 23 months after surgery, 1 died of cardiovascular accident in 19 months after surgery.
ConclusionSurgical excision of the lesion parathyroid tissue is the most effective treatment for PHPT.
Objective To investigate the clinical value on application of endoscopic parathyroiddectomy by gasless unilateral axillary approach, and perioperation management of patients. Methods Twenty-four patients with primary hyperparathyroidism were enrolled and were divided into open group (14 patients underwent open parathyroid surgery) and lumpectomy group (10 patients underwent endoscopic thyroidectomy by gasless unilateral axillary approach) according to the surgical method. All patients received the “5A” model management. The indexes related with perioperative conditions, postoperative incisional pain, and anterior cervical function were compared between the two groups. Results In the open group, 1 patient suffered from transient hoarseness after operation, 5 patients suffered from hypocalcemia on the first day after operation, and 6 patients suffered from temporary hypoparathyroidism. In the lumpectomy group, hypocalcemia occurred in 3 cases and temporary hypoparathyroidism occurred in 3 cases. There were no incision hematoma and infection cases occurred. There was no significant difference between the two groups in the incidence of hypocalcemia and the incidence of temporary hypoparathyroidism after operation (P>0.05). There was no case of incisional hematoma and infection, incisional pain, coughing and sputum excretion or painful swallowing with pain ≥3 in either group. The swallowing disorder index on postoperative day 3 and at 6 months, the scar assessment score and cosmetic satisfaction score at 6 months were higher in the open group than those in the lumpectomy group (P<0.05). Conclusion Patients underwent parathyroidectomy by gasless unilateral axillary approach have the advantages of good cosmetic results and preservation of the function of the anterior cervical region while safely removing the lesion.
ObjectiveTo explore and discuss the effects of lanthanum carbonate on serum calcium and phosphorus of continuous ambulatory peritoneal dialysis (CAPD) patients with chronic renal failure receiving calcitriol pulse therapy due to secondary hyperparathyroidism (SHPT).
MethodsCAPD patients caused by SHPT in peritoneal dialysis centre of the Qingdao Municipal Hospital of Eastern Hospital from March to June, 2013 were selected and randomly divided into two groups (lanthanum carbonate group and calcium carbonate group). The lanthanum carbonate group were treated with oral lanthanum carbonate and calcitriol pulse therapy, while the calcium carbonate group were treated with calcium carbonate and calcitriol. Change of levels of serum calcium, phosphorus and iPTH were observed and statistic analysis was conducted using SPSS 17.0.
ResultsA total of 40 CAPD patients were included, 20 cases in each group. After 12-week treatment, levels of serium phosphate (t=5.095, P=0.000) and iPTH (t=1.225, P=0.000) in the lanthanum carbonate group were significantly lower than those before treatment. The levels of serum calcium (t=1.127, P=0.001) and phosphate (t=2.035, P=0.000) in the lanthanum carbonate group were significantly lower than those in the calcium carbonate group (P < 0.05).
ConclusionLanthanum carbonate serves as a useful approach to improve hypercalcemia and the hyperphosphatemia in CAPD patients receiving calcitriol pulse therapy due to SHPT.
Objective
To analysis causes of reoperation for primary hyperparathyroidism and its clinical characteristics.
Method
The clinical data of the patients with primary hyperparathyroidism who had undergone reoperation from January 1993 to May 2017 were retrospectively analyzed.
Results
A total of 11 patients underwent reoperation were collected in the 226 patients with primary hyperparathyroidism. Of the 11 cases, 8 cases underwent twice operations, 2 cases underwent thrice operations, 1 case underwent quintic operation. After the initial operation, 3 cases were persistent diseases and 7 cases were recurrent diseases, 1 patient was not defined as the persistent or recurrent disease. The main clinical manifestations before the reoperation were fatigue, pain in joints, bones, or muscle. The reasons for reoperation included 3 cases of ectopic parathyroid lesions, 3 cases of recurrent parathyroid carcinomas, 1 case of enlarged operation extent for parathyroid carcinoma, 2 cases of regrowth of double parathyroid aedomas, 1 case of missing adenoma, 1 case of parathyroid hyperplasia. Among the location examinations, the 99Tcm-MIBI was most sensitivity (8/9). Eight cases were received reoperation on the original incision, and the remaining 3 ectopic parathyroid lesions on the new incision. After the reoperation, 2 patients were lost of follow-up, 1 patient died, and the remaining 8 patients had no recurrences during follow-up period.
Conclusion
A comprehensive approach with multiple imageology examinations which attribute to accurate location of lesions, experienced surgeons and well knowledge of parathyroid anatomy and embryology help to descend reoperation ratio and improve success rate of reoperation.
ObjectiveTo investigate the role of multiple disciplinary team (MDT) during surgical treatment of renal secondary hyperparathyroidism (SHPT), and identify management points of Departments of Nephrology and Endocrinology.MethodsThe data of patients with chronic kidney disease undergoing surgical treatment for SHPT in West China Hospital of Sichuan University between January 2009 and December 2018 were retrospectively collected. We explained the surgical treatment of MDT in the management of renal SHPT, and compared the changes before and after the establishment of MDT.ResultsA total of 187 patients including 101 males and 86 females were enrolled, with an average age of (47.60±11.28) years old and median dialysis vintage of 7 years. Under MDT, the number of patients with parathyroidectomy increased [(8.50±5.10) vs. (59.50±2.12) patients/year, P<0.001] and the completion rate of preoperative examinations were greatly improved (P<0.001). The success rate of surgery was also increased (86.8% vs. 97.5%, P=0.010). Proportion of patients who were admitted to the Department of Nephrology was significantly increased (39.7% vs. 84.9%, P<0.001). Most patients after surgery were transferred to the Department of Endocrinology (5.9% vs. 77.3%, P<0.001) to manage postoperative complications and metabolic bone disease, and thus normalized the management of SHPT.ConclusionsThe MDT contributes to management of renal SHPT, which is worthy of popularization and spreading. The management of internal medicine departments during surgical treatment of SHPT based on MDT is important, because they can be helpful to complete preoperative examinations and preoperative preparation as well as to alleviate postoperative complications.
ObjectiveTo compare the efficacy of subtotal parathyroidectomy(sPTX) and total parathyroidectomy (tPTX) plus parathyroid autotransplantation(AT) in treatment of secondary hyperparathyroidism(SHPT).
MethodsClinical 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).
ResultsOf 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).
ConclusiontPTX+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.
