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Surgical management for persistent and recurrent renal hyperparathyroidism / 中华普通外科杂志
Chinese Journal of General Surgery ; (12): 766-770, 2019.
Article in Chinese | WPRIM | ID: wpr-791810
ABSTRACT
Objective To investigate the surgical treatment strategies for persistent and recurrent parathyroidectomy after total parathyroidectomy plus autotransplantation (tPTX + AT) in cases of renal hyperparathyroidism.Methods From Oct 2009 to Oct 2018,480 patients with renal hyperparathyroidism received tPTX + AT in our hospital.32 patients suffered from post-op persistent (31) and recurrent (1) hyperparathyroidism.The high frequency ultrasonography combined with fine needle puncture eluent PTH determination and SPECT/CT co-computed tomography fusion imaging were used as qualitative and localizing diagnostic methods before reoperation.Results Of the 32 patients,28 cases underwent reoperation for once,and 4 underwent reoperations fort wice.36 parathyroid glands and 2 grafts were resected.In 31 patients the bone pain,skin pruritus relieved significantly or disappeared,and muscle strength gradually increased compared with that before operation.Level of iPTH in 31 patients fluctuated between 15 and 90 ng/L.Postoperative parathyroid hormone decreased compared with that before the operation (P < 0.05).One patient was still with persistent hyperparathyroidism despite reoperation,whose iPTH fluctuated between 550 and 1 000 ng/L during 6 months to 2 years follow-up.Conclusion Ultrasonography,FNA-iPTH and SPECT/CT co-computed tomography can be used as methods for qualitative and localizing diagnosis of PTPT or PHPT.With accurate preoperative localization,resection of all parathyroid glands is an effective treatment for postoperative persistent and recurrent renal hyper parathyroidism.

Full text: Available Index: WPRIM (Western Pacific) Type of study: Qualitative research Language: Chinese Journal: Chinese Journal of General Surgery Year: 2019 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Type of study: Qualitative research Language: Chinese Journal: Chinese Journal of General Surgery Year: 2019 Type: Article