Effect of γ-detector guided total parathyroidectomy and auto transplantation in treatment of secondary hyperparathyroidism_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHU Yuxiang ¹ , MOU Hongbin ² ,  LI Chunlian ¹ , WANG Chengcheng ¹ , ZHANG Jiaxin ¹

1. Department of Thyroid and Breast Surgery, Northern Jiangsu Province People’s Hospital, Yangzhou, Jiangsu 225001, P. R. China;
2. Department of Nephrology, Northern Jiangsu Province People’s Hospital, Yangzhou, Jiangsu 225001, P. R. China;

Corresponding author：

LI Chunlian, Email: chunlianlccl@163.com

Keywords：

secondary hyperparathyroidism; gamma detector; total parathyroidectomy; auto transplantation; effect

DOI：

10.7507/1007-9424.202109002

Video：

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Objective To explore the application value of intraoperative gamma detector in patients with chronic kidney disease secondary hyperparathyroidism (sHPT) undergoing total parathyroidectomy (tPTX)+auto transplantation (AT). Methods A retrospective analysis of the clinical data of 110 sHPT patients who received tPTX+AT at Northern Jiangsu Province People’s Hospital from July 2014 to June 2019 was performed. Among them, 80 patients underwent tPTX+AT guided by the gamma detector during the operation (observation group), 30 patients underwent tPTX+AT under routine exploration (control group). We compared the operation time, number of parathyroid glands removed, serum intact parathyroid hormone (iPTH) concentration, serum calcium and phosphorus levels, as well as the occurrence of postoperative complications and recurrence rate were compared between the two groups. Results The number of parathyroid glands removed of the control group was lower than that of the observation group [(3.87±0.35) per case vs. (4.01±0.11) per case, P<0.05], but the operation time of the control group was longer [(115±25) min vs. (75±27) min, P<0.05]. Postoperative iPTH, serum calcium and serum phosphorus levels were significantly reduced in all patients. After the operation, the symptoms of pruritus, bone pain, and muscle weakness were relieved or disappeared. There was no death, dysphagia, drinking water choking cough, and superior laryngeal nerve injury occurred. One patient in the observation group and one patient in the control group had hoarseness, and one patient in the control group had cervical incision bleeding; one patient in the observation group and four patients in the control group suffered short-term postoperative recurrence due to incomplete parathyroidectomy. There was no significant difference in the incidence of complications (χ²=2.413, P>0.05), but the short-term postoperative recurrence rate of the observation group was lower than that of the control group (χ²=7.342, P<0.05). Conclusion Gamma detector is helpful for rapid identification of typical hyperplasia and ectopic parathyroid glands during operation, and can improve the accuracy of tPTX , save operation time, and reduce the recurrence.

Citation： ZHU Yuxiang, MOU Hongbin, LI Chunlian, WANG Chengcheng, ZHANG Jiaxin. Effect of γ-detector guided total parathyroidectomy and auto transplantation in treatment of secondary hyperparathyroidism. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(7): 933-938. doi: 10.7507/1007-9424.202109002 Copy

1.	Komaba H, Taniguchi M, Wada A, et al. Parathyroidectomy and survival among Japanese hemodialysis patients with secondary hyperparathyroidism. Kidney Int, 2015, 88(2): 350-359.
2.	Yamamoto S, Fukagawa M. Uremic toxicity and bone in CKD. J Nephrol, 2017, 30(5): 623-627.
3.	Zhang Y, Zhang DZ. Circulating parathyroid hormone and risk of hypertension: a meta-analysis. Clin Chim Acta, 2018, 482: 40-45.
4.	张洪彬, 赵寒辉, 王素霞, 等. 继发性甲状旁腺功能亢进的发病机制和诊治. 临床肾脏病杂志, 2021, 21(11): 950-955.
5.	张凌. 继发性甲状旁腺功能亢进的治疗策略. 中华肾病研究电子杂志, 2015, 4(3): 118-122.
6.	王海峰, 张凌, 姚力. 三种不同甲状旁腺切除术治疗继发性甲状旁腺功能亢进425例疗效比较. 中国血液净化, 2016, 15(9): 455-458.
7.	王红鹰, 黄骏文, 邹强, 等. 甲状旁腺全切除加前臂自体移植术治疗肾性继发性甲状旁腺功能亢进的长期疗效. 外科理论与实践, 2018, 23(6): 523-527.
8.	Xue J, Liu Y, Ji T, et al. Comparison between technetium-99m methoxyisobutylisonitrile scintigraphy and ultrasound in the diagnosis of parathyroid adenoma and parathyroid hyperplasia. Nucl Med Commun, 2018, 39(12): 1129-1137.
9.	乔楠, 付庆锋, 李鸿博, 等. 继发性甲状旁腺功能亢进外科治疗中甲状旁腺自体移植现状. 中国实用外科杂志, 2019, 39(4): 379-381.
10.	中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 慢性肾功能衰竭继发甲状旁腺功能亢进外科临床实践专家共识. 中国实用外科杂志, 2016, 36(5): 481-486.
11.	Mehrabibahar M, Mousavi Z, Sadeghi R, et al. Feasibility and safety of minimally invasive radioguided parathyroidectomy using very low intraoperative dose of Tc-99m MIBI. Int J Surg, 2017, 39: 229-233.
12.	刘岩, 王岐, 杨路路, 等. ⁹⁹Tc^m-MIBI双时相显像对甲状旁腺腺瘤和甲状旁腺增生的诊断价值. 中国普外基础与临床杂志, 2021, 28(11): 1457-1461.
13.	张峻嘉, 边学海. 甲状旁腺术中识别方法的进展与探讨. 中国普通外科杂志, 2018, 27(5): 629-634.
14.	陈安举, 王田田, 薄少军, 等. 术中甲状旁腺激素测定在继发性甲状旁腺功能亢进手术中的临床应用价值. 临床耳鼻咽喉头颈外科杂志, 2019, 33(12): 1168-1172.
15.	胡茂飞, 刘庆, 高新春, 等. 难治性SHPT治疗新理念: 甲状旁腺肃清手术. 中国现代普通外科进展, 2018, 21(8): 623-627.
16.	吴承倢, 卢春燕. 术后骨饥饿综合征. 中国普外基础与临床杂志, 2021, 28(2): 265-270.
17.	Chou FF, Chi SY, Hsieh KC. Hypoparathyroidism after total parathyroidectomy plus subcutaneous autotransplantation for secondary hyperparathyroidism－any side effects? World J Surg, 2010, 34(10): 2350-2354.
18.	Yuan F, Yu W, Waqas A, et al. Radioactive probe-guided parathyroidectomy for secondary hyperparathyroidism. Chin Med J (Engl), 2014, 127(13): 2413-2418.
19.	Li C, Lv L, Wang H, et al. Total parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: systematic review and meta-analysis. Ren Fail, 2017, 39(1): 678-687.
20.	汪燕, 周莉, 付平. 手术治疗继发性甲状旁腺功能亢进多学科协作中的内科管理. 华西医学, 2019, 34(7): 759-763.

1. Komaba H, Taniguchi M, Wada A, et al. Parathyroidectomy and survival among Japanese hemodialysis patients with secondary hyperparathyroidism. Kidney Int, 2015, 88(2): 350-359.
2. Yamamoto S, Fukagawa M. Uremic toxicity and bone in CKD. J Nephrol, 2017, 30(5): 623-627.
3. Zhang Y, Zhang DZ. Circulating parathyroid hormone and risk of hypertension: a meta-analysis. Clin Chim Acta, 2018, 482: 40-45.
4. 张洪彬, 赵寒辉, 王素霞, 等. 继发性甲状旁腺功能亢进的发病机制和诊治. 临床肾脏病杂志, 2021, 21(11): 950-955.
5. 张凌. 继发性甲状旁腺功能亢进的治疗策略. 中华肾病研究电子杂志, 2015, 4(3): 118-122.
6. 王海峰, 张凌, 姚力. 三种不同甲状旁腺切除术治疗继发性甲状旁腺功能亢进425例疗效比较. 中国血液净化, 2016, 15(9): 455-458.
7. 王红鹰, 黄骏文, 邹强, 等. 甲状旁腺全切除加前臂自体移植术治疗肾性继发性甲状旁腺功能亢进的长期疗效. 外科理论与实践, 2018, 23(6): 523-527.
8. Xue J, Liu Y, Ji T, et al. Comparison between technetium-99m methoxyisobutylisonitrile scintigraphy and ultrasound in the diagnosis of parathyroid adenoma and parathyroid hyperplasia. Nucl Med Commun, 2018, 39(12): 1129-1137.
9. 乔楠, 付庆锋, 李鸿博, 等. 继发性甲状旁腺功能亢进外科治疗中甲状旁腺自体移植现状. 中国实用外科杂志, 2019, 39(4): 379-381.
10. 中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 慢性肾功能衰竭继发甲状旁腺功能亢进外科临床实践专家共识. 中国实用外科杂志, 2016, 36(5): 481-486.
11. Mehrabibahar M, Mousavi Z, Sadeghi R, et al. Feasibility and safety of minimally invasive radioguided parathyroidectomy using very low intraoperative dose of Tc-99m MIBI. Int J Surg, 2017, 39: 229-233.
12. 刘岩, 王岐, 杨路路, 等. ⁹⁹Tc^m-MIBI双时相显像对甲状旁腺腺瘤和甲状旁腺增生的诊断价值. 中国普外基础与临床杂志, 2021, 28(11): 1457-1461.
13. 张峻嘉, 边学海. 甲状旁腺术中识别方法的进展与探讨. 中国普通外科杂志, 2018, 27(5): 629-634.
14. 陈安举, 王田田, 薄少军, 等. 术中甲状旁腺激素测定在继发性甲状旁腺功能亢进手术中的临床应用价值. 临床耳鼻咽喉头颈外科杂志, 2019, 33(12): 1168-1172.
15. 胡茂飞, 刘庆, 高新春, 等. 难治性SHPT治疗新理念: 甲状旁腺肃清手术. 中国现代普通外科进展, 2018, 21(8): 623-627.
16. 吴承倢, 卢春燕. 术后骨饥饿综合征. 中国普外基础与临床杂志, 2021, 28(2): 265-270.
17. Chou FF, Chi SY, Hsieh KC. Hypoparathyroidism after total parathyroidectomy plus subcutaneous autotransplantation for secondary hyperparathyroidism－any side effects? World J Surg, 2010, 34(10): 2350-2354.
18. Yuan F, Yu W, Waqas A, et al. Radioactive probe-guided parathyroidectomy for secondary hyperparathyroidism. Chin Med J (Engl), 2014, 127(13): 2413-2418.
19. Li C, Lv L, Wang H, et al. Total parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: systematic review and meta-analysis. Ren Fail, 2017, 39(1): 678-687.
20. 汪燕, 周莉, 付平. 手术治疗继发性甲状旁腺功能亢进多学科协作中的内科管理. 华西医学, 2019, 34(7): 759-763.

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Effect of γ-detector guided total parathyroidectomy and auto transplantation in treatment of secondary hyperparathyroidism

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