关键词: 肾移植, 三发性甲状旁腺功能亢进, 甲状旁腺切除术, 微波消融术

Abstract: Ｏｂｊｅｃｔｉｖｅ：To investigate the efficacy of parathyroidectomy (PTX) and microwave ablation (MWA) in the treatment of tertiary hyperparathyroidism (THPT) after renal transplantation and its effect on renal allograft function.
Ｍｅｔｈｏｄｏｌｏｇｙ：The clinical data of THPT patients after renal transplantation who successfully received PTX and MWA treatment in ChinaJapan Friendship Hospital and Beijing Chuiyangliu Hospital from April 13, 2016 to August 20, 2020 were retrospectively analyzed.The changes of serum calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone (iPTH) and serum creatinine were compared before operation and 1 day, 1 month, 3 months, 6 months and 12 months after operation. The success rate of operation, postoperative complications and recurrence of THPT were counted.
Ｒｅｓｕｌｔｓ：There were 12 patients treated with PTX and 20 patients treated with MWA with complete data were included. The preoperative iPTH values of PTX and MWA groups were 3343 (1307,4752) pg／mL and 1934 (1322,2971) pg／mL, respectively, which decreased to 745(146,1781) pg／mL and 669 (388,987) pg／mL one day after operation, respectively. There were statistically significant differences in iPTH values between the two groups at each time point before and after treatment(χ2PTX=31232, P<001;χ2MWA=49680, P<001).Alkaline phosphatase showed a downward trend with statistical significance after treatment(χ2PTX=35477, P<001;χ2MWA=29583, P<001).The mean values of blood calcium in PTX and MWA groups before treatment were (278±039) mmol／L and (273±023) mmol／L, respectively, and decreased to (239±031) mmol／L and (251±022) mmol／L on the first day after treatment. Analysis of variance of repeated measurements showed that the difference was statistically significant(FPTX=6617, P<001;FMWA=3776, P=0021).There were no significant differences in serum phosphorus or creatinine at each time point after PTX and MWA compared with those before surgery (P>005).The recurrence rate of PTX group was lower than that of MWA group, but the difference was not statistically significant (P>005).
Ｃｏｎｃｌｕｓｉｏｎ：Both PTX and MWA can effectively improve the high PTH, high ALP and hypercalcemia caused by THPT after renal transplantation. It is a safe and effective method, and has no effect on the function of transplanted kidney. Compared with MWA, the recurrence rate of THPT after PTX was lower.

Key words: kidney transplantation, tertiary hyperparathyroidism, parathyroidectomy, microwave ablation