a Department of General Surgery , Affiliated Hospital of Qingdao University , Qingdao , China.
b Department of Ultrasound , Affiliated Hospital of Qingdao University , Qingdao , China.
Ren Fail. 2017 Nov;39(1):678-687. doi: 10.1080/0886022X.2017.1363779.
Total parathyroidectomy (tPTX) and total parathyroidectomy with autotransplantation (tPTX + AT) are effective and inexpensive treatments for secondary hyperparathyroidism (sHPT), but we do not know which one is the optimal approach. Therefore, we undertook a meta-analysis to compare the safety and efficacy of these two surgical procedures.
Studies published in English on PubMed, Embase and the Cochrane Library from inception to 27 September 2016 were searched systematically. Eligible studies comparing tPTX with tPTX + AT for sHPT were included and Review Manager v5.3 was used.
Eleven studies were included in this meta-analysis. Ten cohort studies and one randomized controlled trial (RCT) involving 1108 patients with sHPT were identified. There was no significant difference in the prevalence of surgical complications (relative risk [RR], 1.71; 95% confidence interval [CI], 0.77-3.79; p = .19), all-cause mortality (RR, 0.68; 95% CI, 0.33-1.39; p = .29), sHPT persistence (RR, 3.81; 95% CI, 0.56-25.95; p = .17) or symptomatic improvement (RR, 1.02; 95% CI, 0.91-1.13; p = .79). tPTX could reduce the risk of sHPT recurrence (RR, 0.19; 95% CI, 0.09-0.41; p < .0001) and reoperation because of recurrence or persistence of sHPT (RR, 0.46; 95% CI 0.24-0.86; p = .01) compared with tPTX + AT. Simultaneously, tPTX increased the risk of hypoparathyroidism (RR, 2.63; 95% CI, 1.06-6.51; p = .04).
We found tPTX and tPTX + AT to be useful methods for sHPT treatment. tPTX was superior for reducing the risk of sHPT recurrence and reoperation than tPTX + AT but, due to a lack of high statistical-power RCTs, comparative studies will be needed in the future.
甲状旁腺全切除术（tPTX）和甲状旁腺全切除加自体移植术（tPTX+AT）是治疗继发性甲状旁腺功能亢进症（sHPT）的有效且经济实惠的方法，但我们并不知道哪种方法是最佳方法。因此，我们进行了一项荟萃分析，以比较这两种手术的安全性和疗效。
系统地检索了从建库至 2016 年 9 月 27 日在 PubMed、Embase 和 Cochrane 图书馆发表的英文文献。纳入了比较 tPTX 与 tPTX+AT 治疗 sHPT 的研究，并使用 Review Manager v5.3 进行分析。
共有 11 项研究纳入了本次荟萃分析。共纳入了 10 项队列研究和 1 项随机对照试验（RCT），涉及 1108 例 sHPT 患者。手术并发症的发生率（相对风险 [RR]，1.71；95%置信区间 [CI]，0.77-3.79；p=0.19）、全因死亡率（RR，0.68；95%CI，0.33-1.39；p=0.29）、sHPT 持续存在（RR，3.81；95%CI，0.56-25.95；p=0.17）或症状改善（RR，1.02；95%CI，0.91-1.13；p=0.79）均无显著差异。与 tPTX+AT 相比，tPTX 可降低 sHPT 复发（RR，0.19；95%CI，0.09-0.41；p<0.0001）和因 sHPT 复发或持续存在而再次手术（RR，0.46；95%CI，0.24-0.86；p=0.01）的风险。同时，tPTX 增加了甲状旁腺功能减退症的风险（RR，2.63；95%CI，1.06-6.51；p=0.04）。
我们发现 tPTX 和 tPTX+AT 都是治疗 sHPT 的有效方法。与 tPTX+AT 相比，tPTX 降低 sHPT 复发和再次手术的风险更优，但由于缺乏高统计学效能的 RCT，未来仍需要进行比较研究。
