Chemical ablation of recurrent and persistent secondary hyperparathyroidism after subtotal parathyroidectomy
| Autor: | Han-Hsiang Chen, Tseng-Long Yang, Jackson Lin, Chuan-Tsai Lai, Shin-Ping Cheng, Chih-Jen Wu, Cheng-Jui Lin |
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| Rok vydání: | 2011 |
| Předmět: |
Parathyroidectomy
Ablation Techniques Male medicine.medical_specialty medicine.medical_treatment Scintigraphy Administration Cutaneous Subtotal Parathyroidectomy Cohort Studies Parathyroid Glands Postoperative Complications Recurrence Renal Dialysis Medicine Humans Prospective cohort study Aged Retrospective Studies Hyperparathyroidism Chi-Square Distribution medicine.diagnostic_test Ethanol business.industry Retrospective cohort study Middle Aged medicine.disease Surgery Treatment Outcome Chronic Disease Secondary hyperparathyroidism Female Hyperparathyroidism Secondary Percutaneous ethanol injection business Follow-Up Studies |
| Zdroj: | Annals of surgery. 253(4) |
| ISSN: | 1528-1140 |
| Popis: | BACKGROUND Despite preoperative localization or intraoperative parathyroid hormone, monitoring increased the operative successful rate, recurrent, and persistent secondary hyperparathyroidism are still unavoidable after parathyroidectomy or reoperation. We present our experience of using percutaneous ethanol injection therapy (PEIT) in treating these patients. PURPOSE To conduct a prospective study of 49 patients with recurrent and persistent hyperparathyroidism using PEIT after subtotal parathyroidectomy or reoperative failure. PATIENTS AND METHODS From January 2001 to August 2009, 49 patients with recurrent or persistent 2HPT after subtotal parathyroidectomy received PEIT. All dialysis patients were divided into 2 groups: recurrent group (n = 28) and persistent group (n = 21). Before PEIT, every patient received sestamibi-(99m)Tc scintigraphy (MIBI scanning), neck ultrasonography (US), bone scanning (T-score and Z-score), and parathyroid function testing. We compared the responses to PEIT treatment in the recurrent and persistent groups with the following parameters: treatment success rate, improvement in bone density, concurrence in diagnosis between US and MIBI scanning and complications. RESULTS Treatment success was defined as intact PTH < 300 pg/mL; recurrent group is 25 of 28 (89.3%) and persistent group is 20 of 21 (95.2%) (P = 0.694). There was no difference in success rate statistically. T-score in recurrent group before PEIT was -1.2 ± 0.9 and after treatment was -0.6 ± 0.6 (P = 0.004), which is statistically significant. In the persistent group, T-score before PEIT was -1.2 ± 1.0 and after treatment was -0.8 ± 0.6 (P = 0.101). There was no significant difference. For consistence between neck US and MIBI scanning were concordant in the recurrent group in 20 of 28 (71.4%); in persistent group, it was 14 of 21 (66.6%) (P = 0.245); there was no significant difference. Regarding the complications, only hypocalcemia was significantly more common in the recurrent group. Hypocalcemia occurred in 14 of 28 patients in the recurrent group and 6 of 21 in the persistent group (P = 0.022). CONCLUSIONS Regardless of which group patient was in, PEIT can achieve satisfying result when parathyroid masses were detected by US. Subtotal parathyroidectomy plus PEIT was probably the best combination for treatment of secondary hyperparathyroidism. |
| Databáze: | OpenAIRE |
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