ObjectiveTo investigate the significance of 99Tcm-MIBI SPECT dual-phase imaging, B-ultrasound and CT in the diagnosis of primary hyperparathyroidism, and its relationship with the level of serum calcium (CA). MethodsThe clinical data of 73 patients with parathyroid dysfunction (serum parathyroid hormone (PTH) > 130 pg/mL) were retrospectively analyzed. The 99Tcm-MIBI SPECT double phase imaging were performed in 73 cases, 63 cases underwent cervical B-ultrasound examination, and 16 cases underwent CT examination. According to the serum calcium (CA) levels, the patients were divided into CA < 2.7 mmol/L group and CA > 2.7 mmol/L group, and the postoperative pathological examination and followed-up results were as the standard, the sensitivity, specificity, positive predictive value, and negative predictive value of 99Tcm-MIBI SPECT dual-phase imaging, B-ultrasound and CT for diagnosis of PHPT in different serum CA levels were compared. ResultsThe sensitivity of 99Tcm-MIBI SPECT dual-phase imaging, B-ultrasound and CT examination for diagnosis of PHPT was 87.6%, 81.8% and 35.7%, respectively; the specificity was 87.5%, 75.5% and 50.0%, respectively; the positive predictive value was 98.2%, 93.7% and 83.3%, respectively; and the negative predictive value was 46.7%, 33.3% and 10%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of 99Tcm-MIBI SPECT dual-phase imaging and B-ultrasound examination for diagnosis of PHPT were significantly higher than those of CT examination(P < 0.05). The sensitivity, specificity, positive predictive value and negative predictive value of 99Tcm-MIBI SPECT dual-phase imaging for diagnosis of PHPT were higher than those of B-ultrasound examination, but the difference was not statistically significant (P > 0.05). In the CA < 2.7 mmol/L group, the sensitivity of 99Tcm-MIBI SPECT dual-phase imaging, B-ultrasound and CT examination for diagnosis of PHPT was 91.1%, 84.7% and 37.9%, respectively; the specificity was 80.2%, 72.9% and 49.7%, respectively; the positive predictive value was 96.8%, 96.0% and 79.4%, respectively; and the negative predictive value was 50.0%, 37.5% and 10.0%. In the CA > 2.7 mmol/L group, The sensitivity of 99Tcm-MIBI SPECT dual-phase imaging, B-ultrasound and CT examination for diagnosis of PHPT was 87.9%, 83.9% and 42.8%, respectively; the specificity was 83.3%, 79.2% and 50.0%, respectively; the positive predictive value was 96.9%, 94.1% and 75.0%, respectively; and the negative predictive value was 50.0%, 40.5% and 20.0%. There were no significant difference in the diagnostic accuracy between the 3 methods and the level of serum CV in different levels. ConclusionsThe diagnostic accuracy of 99Tcm-MIBI SPECT dual-phase imaging and B-ultrasound examination for diagnosis of PHPT patients with PTH > 130 pg/mL (especially parathyroid adenoma) were higher than that of CT examination, and it is not associated with the serum CA concentration.
ObjectiveTo investigate the role of multiple disciplinary team (MDT) during surgical treatment of renal secondary hyperparathyroidism (SHPT), and identify management points of Departments of Nephrology and Endocrinology.MethodsThe data of patients with chronic kidney disease undergoing surgical treatment for SHPT in West China Hospital of Sichuan University between January 2009 and December 2018 were retrospectively collected. We explained the surgical treatment of MDT in the management of renal SHPT, and compared the changes before and after the establishment of MDT.ResultsA total of 187 patients including 101 males and 86 females were enrolled, with an average age of (47.60±11.28) years old and median dialysis vintage of 7 years. Under MDT, the number of patients with parathyroidectomy increased [(8.50±5.10) vs. (59.50±2.12) patients/year, P<0.001] and the completion rate of preoperative examinations were greatly improved (P<0.001). The success rate of surgery was also increased (86.8% vs. 97.5%, P=0.010). Proportion of patients who were admitted to the Department of Nephrology was significantly increased (39.7% vs. 84.9%, P<0.001). Most patients after surgery were transferred to the Department of Endocrinology (5.9% vs. 77.3%, P<0.001) to manage postoperative complications and metabolic bone disease, and thus normalized the management of SHPT.ConclusionsThe MDT contributes to management of renal SHPT, which is worthy of popularization and spreading. The management of internal medicine departments during surgical treatment of SHPT based on MDT is important, because they can be helpful to complete preoperative examinations and preoperative preparation as well as to alleviate postoperative complications.
ObjectiveTo explore the selection and application value of preoperative stereotactic localization in the surgical treatment of secondary hyperparathyroidism.MethodsThe preoperative ultrasound, CT, and methoxyisobutylisonitrile (MIBI) scan data of 54 patients with secondary hyperparathyroidism confirmed by pathological examination in the Department of General Surgery of the 900th Hospital of the Joint Logistics Team from September 2016 to January 2020 were retrospectively analyzed, to explore the localization accuracy of the three methods alone or in combination.ResultsIn this study, a total of 207 parathyroids were detected, 1 was misdiagnosed (ectopic thymus),9 were missed, and 216 parathyroids were removed. The preoperative localization accuracy of CT, ultrasound, and MIBI was the highest (95.39%, 207/217), followed by ultrasound and MIBI (93.55%, 203/217) and CT+MIBI (89.40%, 194/217), compared with other single or two methods, the differences were statistically significant (P<0.05). The accuracy of CT combined with ultrasound localization (82.49%, 179/217) was slightly higher than that of MIBI scan alone (78.80%, 171/217), but the difference was not statistically significant (P=0.060). Although the location accuracy of MIBI scan was slightly higher than that of ultrasound localization (77.88%, 169/217), the difference was not statistically significant (P=0.084).ConclusionIn order to maximize the accuracy of preoperative stereotactic localization of secondary hyperparathyroidism, ultrasound, CT, and MIBI should be combined.
Objective To investigate the clinical value on application of endoscopic parathyroiddectomy by gasless unilateral axillary approach, and perioperation management of patients. Methods Twenty-four patients with primary hyperparathyroidism were enrolled and were divided into open group (14 patients underwent open parathyroid surgery) and lumpectomy group (10 patients underwent endoscopic thyroidectomy by gasless unilateral axillary approach) according to the surgical method. All patients received the “5A” model management. The indexes related with perioperative conditions, postoperative incisional pain, and anterior cervical function were compared between the two groups. Results In the open group, 1 patient suffered from transient hoarseness after operation, 5 patients suffered from hypocalcemia on the first day after operation, and 6 patients suffered from temporary hypoparathyroidism. In the lumpectomy group, hypocalcemia occurred in 3 cases and temporary hypoparathyroidism occurred in 3 cases. There were no incision hematoma and infection cases occurred. There was no significant difference between the two groups in the incidence of hypocalcemia and the incidence of temporary hypoparathyroidism after operation (P>0.05). There was no case of incisional hematoma and infection, incisional pain, coughing and sputum excretion or painful swallowing with pain ≥3 in either group. The swallowing disorder index on postoperative day 3 and at 6 months, the scar assessment score and cosmetic satisfaction score at 6 months were higher in the open group than those in the lumpectomy group (P<0.05). Conclusion Patients underwent parathyroidectomy by gasless unilateral axillary approach have the advantages of good cosmetic results and preservation of the function of the anterior cervical region while safely removing the lesion.
Objective To evaluate the diagnostic significance and to analyze reasons of false negative cases forpreoperative ultrasonography， 99Tcm-sestamibi scintigraphy （MIBI scintigraphy）， and CT in primary hyperparathyroidism（PHPT）. Methods Clinical data of 69 patients with PHPT， who underwent operation in Affiliated Shengjing Hospital of China Medical University between Jan. 2003 and Aug. 2012 were retrospectively analyzed. Results There were 76 parathyroid lesions in 69 PHPT patients proved by operation and pathology， including 58 cases of parathyroid adenoma with 60 lesions， 7 cases of parathyroid hyperplasia with 11 lesions， and 4 cases of parathyroid carcinoma with 5 lesions. The sensitivity of ultrasonography， CT， and 99Tcm-MIBI scintigraphy were 81.94% （59/72）， 61.76% （21/34）， and 69.57% （16/23）， the accuracy of 3 kinds of tests were 78.67% （59/75）， 61.76% （21/34）， and 66.67% （16/24）， the positive predictive value were 95.16% （59/62）， 100% （21/21）， and 94.12% （16/17） respectively. There was significant differ-ence only between ultrasonography and CT in sensitivity （P=0.03）， no other significant difference was found （P＞0.05）.Conclusions Ultrasonography is complementary to 99Tcm-MIBI scintigraphy， but CT has little significance in diagnosis of PHPT. Both of ultrasonography and 99Tcm-MIBI scintigraphy should be used before operation routinely to localize parathyroid lesions.
ObjectiveTo analyze the factors influencing the hungry bone syndrome (HBS) in patients with secondary hyperparathyroidism (SHPT) after parathyroidectomy. MethodsThe clinical data of patients who underwent parathyroidectomy for SHPT in the 900th Hospital of the Joint Logistics Support Force from January 2016 to May 2021 were retrospectively analyzed. The risk factors for HBS were analyzed by binary logistic regression analysis. The cut-off value of risk factors for predicting postoperative HBS was analyzed by using recieve operating characteristic (ROC) curve. ResultsA total of 89 patients were included in this study, including 44 males and 45 females, with (47±11) years old. There were 42 (47.2%) patients with HBS. Compared with the patients without HBS, the patients with HBS was younger and had higher levels of preoperative parathyroid hormone, potassium, and alkaline phosphatase (ALP), the differences were statistically different (P<0.05). The multivariate binary logistic regression analysis showed that the higher preoperative ALP level was a risk factor for the HBS [OR (95%CI) = 1.014 (1.007, 1.020), P<0.001]. The area under the ROC curve (95%CI) of the preoperative ALP level in distinguishing the patients with HBS from without HBS was 0.957 (0.919, 0.996), and the optimal cut-off value of ALP for predicting postoperative HBS was 278.90 U/L. ConclusionsFrom the preliminary results of this study, it can be concluded that bone conversion status can be differentiated according to preoperative ALP level in patients with SHPT. When preoperative ALP level is higher than cut-off value, it is recommended that calcium supplementation should be given as soon as possible and blood calcium level should be closely monitored.
Vague preoperative localization and ectopic parathyroid often lead to the failure of operation in primary hyperparathyroidism. From Jun 1989 to March 1998, 11 cases of primary hyperparathyroidism had been treated surgically in the general surgery department of our hospital. Of them, 10 cases were operated successfully with the pathological diagnosis of adenoma and one parathyroid removed was reported normal. Preoperative localization, the knowledge of ectopic parathyroids, careful exploration during operation and the postoperative medical treatment are important for the perioperative management. Postoperative followup has emphasized to benefit the treatment in primary hyperparathyroidism.
ObjectiveTo summarize the current treatment status of uremic secondary hyperparathyroidism (SHPT) in order to improve the understanding of uremic SHPT and to guide clinical work.MethodThe relevant literatures at home and abroad on surgical treatment of uremic SHPT were readed and reviewed.ResultsFor intractable SHPT patients with ineffective medical treatment, surgical treatment was still irreplaceable, which could significantly improve biochemical indicators and quality of life of SHPT patients. However, there was no unified standard for surgical indications and the choice of different operation methods. In addition, there was a certain controversy about whether there was a need for preoperative parathyroidectomy in patients with SHPT who were willing to have a kidney transplant.ConclusionAlthough there are still some problems need to be solved in surgical treatment of SHPT, however, it’s widely recognized and used by clinicians, which can improve the symptoms of SHPT patients and bring bettersurvival benefits.
ObjectiveTo explore therapeutic efficacy of parathyroidectomy (PTX) in treatment of secondary hyperparathyroidism (SHPT) in patients with end-stage renal disease.MethodsThe clinical data of 50 patients who underwent PTX for uremic SHPT from January 2016 to March 2018 were collected retrospectively. The changes of serum calcium, phosphorus, and intact parathyroid hormone (iPTH) before the surgery and 1 d, 7 d, 1 month, 3 months and 12 months after the surgery were analyzed. In addition, the improvement of clinical symptoms together with the postoperative recurrence and complications were observed.ResultsTen patients underwent the subtotal PTX (SPTX), 5 cases underwent the total PTX (TPTX), and 35 cases underwent the TPTX with autotransplantation (TPTX+AT). The PTXs were performed successfully in 47/50 (94.0%) patients. After the PTX, the bone pain and skin itching were alleviated, 3 cases had the temporary injury of recurrent laryngeal nerve and the hypoparathyroidism was found in 1 case. The levels of postoperative serum iPTH, calcemia, and phosphorus were lower than those at the preoperative level, the differences were statistically significant (P<0.050). The postoperative hypocalcemia was frequently seen in 38/50 (76.0%) patients, and it was effectively controlled by the intravenous calcium. After the follow-up for 3 months, the SHPT recurred in 5 cases (10.0%), of whom 3 cases underwent the TPTX+AT. The relapse rate in 12 months after the operation was 9.1% (2/22). There were no statistical differences among the three PTXs methods in the operation successful rate (χ2=3.351, P=0.211) and relapse rates in 3 months (χ2=1.321, P=0.753) and 12 months (χ2=1.794, P=0.411) after the operation.ConclusionsIn China, TPTX+AT is more common than SPTX and TPTX in clinical application. Operations of SPTX, TPTX, and TPTX+AT are safe and effective therapeutic methods for uremic SHPT, which can significantly improve biochemical indicators and quality of life of patients.
ObjectiveTo assess the clinical efficacy of percutaneous transplantation of parathyroid glands into the subcutaneous tissue of the epigastrium for treating malignant secondary hyperparathyroidism (SHPT). MethodsThe clinical data of the patients with SHPT who were treated by puncturing the subcutaneous tissue of the epigastrium and transplanting parathyroid glands in the Xuzhou Central Hospital from January 2020 to June 2022 were collected retrospectively. The preoperative and postoperative parathyroid hormone (PTH) level, calcium ion concentration, alkaline phosphatase (ALP) level, and phosphorus ion concentration, as well as postoperative follow-up results were analyzed. The data analysis was conducted using SPSS 23.0 software, with a testing level of 0.01. ResultsA total of 21 patients successfully underwent this surgery, including 12 males and 9 females, with a median age of 48 years old and a range of 32–71 years old. The dialysis time was (8.62±2.27) years, and 12 patients had hypertension, 9 patients had anemia, 17 patients had bone pain, and 11 patients had skin itching. On day 1 after treatment, the PTH level decreased from (1 893.23±539.30) ng/L to (5.99±3.50) ng/L (P<0.001), the calcium ion concentration decreased from (2.52±0.31) mmol/L to (2.24±0.35) mmol/L (P=0.003), and the phosphorus ion concentration decreased from (2.25±0.71) mmol/L to (1.76±0.38) mmol/L (P=0.006) as compared with the values before surgery. Although the ALP level decreased from (321.78±151.01) U/L to (229.32±89.32) U/L, there was no statistically significant difference (P=0.016). Among the 12 patients with hypertension before surgery, 6 patients improved and reduced the use of antihypertensive drugs after surgery; among the 9 patients with anemia, 3 patients improved before discharge; 17 patients with bone pain showed markedly relief before discharge; and 9 patients with skin itching improved before discharge. There were no complications such as hoarseness, choking cough when drinking water, or incision infection after the operation. All 21 patients were followed up for 6–12 months. The parathyroid hormone levels of the 21 patients all dropped to the normal level within 12 months after the operation. Among them, 3 patients recovered to the normal level at the 3rd month after the operation, 16 patients recovered to the normal level at the 6th month after the operation, and 2 patients recovered to the normal level at the 12th month after the operation. The time to return to the normal level was (5.86±2.70) months. No serious complications occurred in all patients, and there was no recurrent case during follow-up period. Conclusion From the analysis results of our study, parathyroid autotransplantation into the subcutaneous tissue of the epigastrium via puncture is a safe and effective method for patients with SHPT.