关键词: 继发性甲状旁腺功能亢进症, 慢性肾脏病, 甲状旁腺手术切除

Abstract:

ABSTRACT Objective: To explore the effect of total parathyroidectomy with sternocleidomastoid autotransplantation of the parathyroid tissue for treating patients with secondary hyperparathyroidism(SHPT). Methodology: We retrospectively reviewed 32 patients with SHPT treated in the department of Otolaryngology & Head and Neck Surgery of Civil Aviation General Hospital between September 2009 and February 2013. All patients had undergone the dissection of central compartment plus supra anterior mediastinum with parathyroid autograft transplantation in the sternocleidomastoid. We evaluated the efficacy of the operation by comparing serum intact parathyroid hormone (iPTH), serum-ionized calcium, phosphorus, hemoglobin before and after operation. Results: Success rate of our primary surgery is 100%.The rates of bone pain and skin itch were 100% respectively and the same the muscle weakness, restless leg symptoms and poor sleep quality were also significantly alleviated within half a year after the operation. Compared with the preoperative serum iPTH (1492.9±1170.70)pg/ml, serum calium (2.39±0.22)mmol/L, serum phosphorus (2.25±0.60) mmol/L and calcium phosphorus product (67.12±20.35)mg/dL，the serum iPTH (80.62±81.28)pg/ml, serum calium (2.15 ± 0.33) mmol/L, serum phosphorus(1.09 ±0.38)mmol/L and calcium phosphorus product (28.63±10.19)mg/dL decreased significantly in half a year after operation, with statistically significant difference(p<0.01). Hemoglobin increased from (109.60±16.17)g/L in preoperation to (118.45±11.88)g/L in half a year after operation，hematocrit increased from (34.01±5.25)% in preoperation to（37.16±3.42)% in half a year after operation, with statistically significant difference (p<0.05). In our research, a total of 121 parathyroid glands was removed, of which 108 from tracheoesophageal groove，9 from superior mediastinum including thymus, 4 from thyroid parenchyma. Conclusions: Total parathyroidectomy by dissection of central compartment and supra anterior mediastinum with sternocleidomastoid autotransplantation is a beneficial and safe surgical procedure and helps to improve the success rate of surgery for patients on chronic dialysis with uncontrollable SHPT.

Key words: Secondary hyperparathyroidism, Chronic kidney disease, Surgery