Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Int J Hyperthermia. 2022;39(1):907-917. doi: 10.1080/02656736.2022.2097324.
This study aimed to investigate and compare the therapeutic efficacy and safety of ultrasound-guided radiofrequency ablation (RFA), between primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism (SHPT) patients, with or without previous parathyroidectomy (PTX).
A total of 21 patients (7 PHPT, 14 SHPT) underwent RFA for hyperparathyroidism (HPT) at Kaohsiung Chang Gung Memorial Hospital, Taiwan. Five of the 14 SHPT patients had previously received PTX. The laboratory data, volume change of each parathyroid nodule, symptomatic scores, and complications were analyzed and compared between all groups at 1 and 7 days, and at 1, 3, 6, and 12 months after RFA.
After RFA, the volume reduction ratio (VRR) for all patients at the last follow-up was 93.76%, and clinical symptoms significantly improved. At 12 months, all PHPT patients achieved successful treatment of intact PTH (iPTH). In SHPT patients, the mean iPTH value significantly decreased 1-day post-RFA, subsequently exhibiting a transient rebound which proceeded to decrease, with 57.1% reaching successful treatment standards. SHPT patients with PTX showed a lower complication score, shorter ablation time, higher iPTH baseline and outcomes, and lower VRR, compared to patients without PTX. The serum calcium level significantly decreased to normal range in 85.7% of all patients at 12 months. Severe hypocalcemia occurred in 23.8% at 1 week, and all were corrected with calcium supplements.
RFA demonstrates a therapeutic efficacy similar to PTX. It can thus be considered an effective alternative treatment for PHPT, SHPT, or post-PTX patients who are unsuitable for another PTX.
本研究旨在探讨和比较超声引导下射频消融（RFA）治疗原发性甲状旁腺功能亢进症（PHPT）和继发性甲状旁腺功能亢进症（SHPT）患者，以及有或无甲状旁腺切除术（PTX）史患者的疗效和安全性。
在台湾高雄长庚纪念医院，共有 21 名患者（7 名 PHPT，14 名 SHPT）因 HPT 接受 RFA。14 名 SHPT 患者中有 5 名曾接受过 PTX。分析和比较了所有组在 1 天和 7 天、RFA 后 1、3、6 和 12 个月时的实验室数据、每个甲状旁腺结节的体积变化、症状评分和并发症。
RFA 后，所有患者在最后一次随访时的体积减少率（VRR）为 93.76%，临床症状明显改善。在 12 个月时，所有 PHPT 患者的完整甲状旁腺激素（iPTH）均达到成功治疗标准。在 SHPT 患者中，iPTH 值在 RFA 后 1 天显著降低，随后出现短暂反弹，随后继续下降，57.1%达到成功治疗标准。与无 PTX 史的患者相比，有 PTX 史的 SHPT 患者的并发症评分较低、消融时间较短、iPTH 基线和结果较高、VRR 较低。所有患者的血清钙水平在 12 个月时显著降至正常范围（85.7%）。23.8%的患者在 1 周时出现严重低钙血症，所有患者均通过补钙得到纠正。
RFA 显示出与 PTX 相似的疗效。因此，它可以被认为是 PHPT、SHPT 或不适合再次 PTX 的 PTX 后患者的有效替代治疗方法。
