Therapeutic effectiveness of total parathyroidectomy with forearm autograft for renal refractory secondary hyperthyroidism through follow-up analysis
Objective To observe the curative effectiveness of total parathyroidectomy with forearm autograft(PTX+ AT) for severe secondary hyperparathyroidism(SHPT) in the end stage renal disease(ESRD) patients.Methods During February 2011 to December 2013,93 patients who underwent PTX + AT for ESRD and SHPT i...
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| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | zho |
| Published: |
Editorial Department of Journal of Clinical Nephrology
2015-01-01
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| Series: | Linchuang shenzangbing zazhi |
| Subjects: | |
| Online Access: | http://www.lcszb.com/thesisDetails?columnId=57920581&Fpath=home&index=0 |
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| Summary: | Objective To observe the curative effectiveness of total parathyroidectomy with forearm autograft(PTX+ AT) for severe secondary hyperparathyroidism(SHPT) in the end stage renal disease(ESRD) patients.Methods During February 2011 to December 2013,93 patients who underwent PTX + AT for ESRD and SHPT in the Second Hospital of Anhui Medical University were followed up over a 6- month period in this study.Blood parameters including calcium,phosphorus,intact parathyroid hormone(iPTH),alkaline phosphatase(ALP),hemoglobin(Hb) and hematocrit(Hct)levels were measured before and after surgery(1,3,and 6 months).Concomitantly,the blood pressure was measured.The postoperative blood pressure control,symptom relief,complications and recurrence were analyzed.The informed consent was obtained from each patient.Results(1) Of all the 93 cases undergoing PTX+ AT,temporary injury of recurrent laryngeal nerve was found in 7 patients(7.5%),and recovered in 3 months after operation.Postoperative hypocalcemia was frequently seen in 75 cases(80.6%) and could be effectively controlled by postoperative calcium administration.(2)After successful operation,bone pain(74/76),itching(26/26) and insomnia(18/18) were greatly alleviated in most of the patients.Two patients still suffered from bone pain and relieved in 3 months after operation.Weakness,anorexia and malnutrition were alleviated in all patients after surgery.Anemia was gradually alleviated,and the dose of recombinant human erythropoietin(rHuEPO) was reduced after surgery.Serum calcium(P<0.01),phosphorus(P<0.01) and iPTH(P<0.01) levels were significantly reduced after surgery as compared with those preoperation.However,serum calcium,phosphorus and iPTH levels were slowly increased to recommended levels in 3 months after surgery.Of the 74 patients with hypertension,postoperative blood pressure was under control in 49 patients(66.2%).Recurrence was observed in 7 cases(7.5%).Three patients accepted implants parathyroidectomy for recurrence of implantation site.The rest 4 patients had recurrence induced by residual or ectopic parathyroid:three cases underwent PTX again(one case died,and two cases had no recurrence again),and one case did not undergo the surgery because of ectopic parathyroid located on the aortic arch.Conclusions PTX+ AT for SHPT in ESRD patients can ameliorate anemia,increase the rate of blood pressure control,and enhance the levels of blood calcium,phosphorus and iPTH.In conclusion,PTX+ AT is safe,economical and effective in the treatment of renal refractory secondary hyperthyroidism. |
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| ISSN: | 1671-2390 |