Comparison of Total Parathyroidectomy With and Without Autotransplantation
Comparison of Total Parathyroidectomy With and Without Autotransplantation
The purpose of this study is to compare short-term and long-term efficacy of total
 parathyroidectomy with autotransplantation and total parathyroidectomy without
 autotransplantation for Secondary hyperparathyroidism.
Background:Secondary hyperparathyroidism (SHPT) is a common disorder in patients with chronic
 kidney disease. It is caused by permanent stimulation of the orthotopic and heterotopic
 parathyroid tissue due to phosphate retention, hypocalcemia, and vitamin D insufficiency.
 Despite the initiation of new therapeutic agents, several patients will require
 parathyroidectomy.There are three options for the surgical treatment of SHPT:subtotal PTX
 (3.5-gland resection,SPTX), total PTX with autotransplantation(TPTX+AT), and total PTX
 without autotransplantation(TPTX).SPTX and TPTX+AT both leave a fragment of
 activated,proliferated parathyroid tissue.Since the pathophysiological condition of chronic
 renal failure and maintenance dialysis continues, the growth stimulus persists and may cause
 recurrent sHPT.The SPTX procedure has a lesser likelihood of a non-functioning remnant, but
 recurrent disease always requires a neck reoperation that carries a high likelihood of
 recurrent laryngeal nerve palsy.Therefore most surgeons believe that TPTX+AT is a better
 procedure for patients with SHPT.

 Because of the potential complication of permanent hypocalcemia and adynamic bone
 disease,TPTX was not introduced into clinical practice.However,recent retrospective studies
 demonstrated patients after TPTX did not develop permanent hypoparathyroidism and adynamic
 bone disease as initially expected.Postoperative hypocalcemia is temporary.TPTX may provide
 an alternative strategy to the currently performed procedures mainly because of the reported
 lower recurrence rates.An 8-year follow-up study showed the recurrence rates after TPTX is
 7%.Recurrence rates after TPTX+AT is 21.4%,and the site of recurrence is located in
 approximately 80% at the graft and in 20% in the neck.However, to the present there is no
 randomized controlled trial to Compare the effects of total parathyroidectomy with
 autotransplantation and total parathyroidectomy without autotransplantation.The purpose of
 this study is to evaluate the short-term and long-term efficacy of total parathyroidectomy
 without autotransplantation comparison to total parathyroidectomy with autotransplantation.

 Intervention: One hundred patients with SHPT need undergo parathyroidectomy at the Second
 Hospital of Anhui medical university were selected and divided into total parathyroidectomy
 without autotransplantation group and total parathyroidectomy with autotransplantation group,
 each group contains 50 cases.

 Results:

 1. Clinical data include: intact parathyroid hormone,serum calcium,serum
 phosphorus,calcium-phosphorus product,hemoglobin,operation
 time,morbidity,mortality,clinical symptoms and signs,recurrence and reoperation,quality
 of life scores.

 2. Statistical method: groups t-test, analysis of variance were used.
Inclusion Criteria:

 -  Both male and female, aged 18 or older;

 -  Intact parathyroid hormone(iPTH) is more than 9 times the upper limit of the normal
 range (about 600pg/ml), with hypercalcemia or hyperphosphatemia;

 -  Refractory to medical therapy;

 -  Provided written informed consent.

 Exclusion Criteria:

 -  Primary or tertiary hyperparathyroidism;

 -  Familial hyperparathyroidism (MENⅠ, MENⅡ, hereditary HPT);

 -  Neck surgical exploration history;

 -  Parathyroid malignant tumor.