Therapeutic evaluation of total parathyroidectomy with autotransplantation in the treatment of secondary hyperparathyroidism

Objective To evaluate the safety and effectiveness of total parathyroidectomy combining autotransplantation (tPTX+ AT) in the treatment of secondary hyperparathyroidism (SHPT) of patients with maintenance hemodialysis, and to investigate the risk factors for early hypocalcemia after parathyroidectomy. Methods Ninety-three cases of maintenance hemodialysis patients were enrolled who underwent tPTX+ AT surgery due to SHPT in the hospital from January 2013 to November 2016. Clinical data were collected including preoperative and postoperative symptoms, serum calcium, serum phosphorus, serum alkaline phosphatase (ALP), serum intact parathyroid hormone (iPTH), pathological types, and complications. According to the blood calcium level at 24 h after operation, the patients were divided into two groups, the normal blood calcium group (Ca≥2.11 mmol/L) and hypocalcemia group (Ca<2.11 mmol/L). Univariate analysis and stepwise logistic regression were used to analyze the risk factors for early postoperative hypocalcemia. Results The success rate of surgery was 92.5%, with excision of 360 parathyroid glands and 10 ectopic parathyroid glands. The pathological results showed mostly adenoma-like hyperplasia (96.4%). Compared with those preoperative levels, the levels of postoperative iPTH, serum phosphorus, and serum ALP decreased significantly (P<0.05). Hypocalcemia was the most common complication after the operation with the incidence rate of 82.8%. The postoperative serum calcium level was positively correlated with the preoperative blood calcium and age (r=0.300, P<0.01; r=0.265, P<0.01), and negatively correlated with the levels of serum iPTH and serum ALP (r=-0.461, P<0.01; r=-0.477, P<0.01). The preoperative low blood calcium (OR=0.113, P=0.045), high serum ALP level (OR=1.050, P<0.001), and high serum iPTH level (OR=1.002, P=0.004) were independent risk factors for early postoperative hypocalcemia. Conclusion tPTX+ AT could safely, effectively, and rapidly reduce the level of serum iPTH in the patients with maintenance hemodialysis, and improve the body′s calcium and phosphorus metabolism disorders, but attention should be paid to the postoperative hypocalcemia to actively correct it. For patients with high risk factors such as preoperative hypocalcemia, high iPTH, and high ALP levels, positive correction of preoperative hypocalcemia may be an effective intervention to prevent postoperative hypocalcemia. Key words: Total parathyroidectomy combining autotransplantation; Secondary hyperparathyroidism; Hypocalcemia