Total parathyroidectomy and upper arm autograft in the treatment of uremic secondary hyperparathyroidism

Abstract

Objective To study the clinical effect of total parathroidectomy combined with upper arm autograft (TPTX + AT) in the treatment of uremic patients with secondary hyperparathyroidism (SHPT).Methods 30 refractory SHPT patients caused by long-term regular dialysis because of chronic renal disease underwent TPTX + AT.Determined the clinical efficacy by comparing the levels of intact parathyroid hormone (iPTH),serum calcium,serum phosphate,alkaline phosphatase (ALP),hemoglobin (Hb) and clinical symptoms before and after operation.Results No one in 30 cases died after operation.Recurrent laryngeal nerve injury was found in 2 cases (6.6％),postoperative hypocalcemia in 25 cases (79.5％),effectively controlled by intravenous calcium.The levels of iPTH,serum phosphorus,serum calcium 1 day,1 week,1 month,3 months and 6 months after operation significantly lowered than those before operation(P ＜ 0.01).The level of ALP 3,6 months after operation significantly lowered than those before operation (P ＜ 0.01),the level of Hb rose(P ＜ 0.05).Bone pain,itching,myasthenia,insomnia,restless legs syndrome,anemia and nutritional status significantly improved.Conclusion TPTX + AT is a safe and effective treatment method for uremic patients with refractory SHPT. Key words: Parathroidectomy; Transplantation; Autologous; Uremia; Hyperparathyroidism; Secondary