Department of Nephrology, Wujin Hospital Affiliated with Jiangsu University, No. 2 Yongning Road, Changzhou, 213000, Jiangsu, China.
Department of Nephrology, The Wujin Clinical College of Xuzhou Medical University, No. 2 Yongning Road, Changzhou, 213000, Jiangsu, China.
Int Urol Nephrol. 2023 Sep;55(9):2237-2247. doi: 10.1007/s11255-023-03543-y. Epub 2023 Mar 9.
Thermal ablation, including microwave ablation (MWA) and radiofrequency ablation (RFA), has been recommended for the treatment of primary hyperparathyroidism (PHPT) and refractory secondary hyperparathyroidism (SHPT). This meta-analysis was conducted to evaluate the efficacy and safety of MWA and RFA in patients with PHPT and refractory SHPT.
Databases including PubMed, EMbase, the Cochrane Library, CNKI (China National Knowledge Infrastructure), and Wanfang were searched from inception to December 5, 2022. Eligible studies comparing MWA and RFA for PHPT and refractory SHPT were included. Data were analyzed using Review Manager software, version 5.3.
Five studies were included in the meta-analysis. Two were retrospective cohort studies, and three were RCTs. Overall, 294 patients were included in the MWA group, and 194 patients were included in the RFA group. Compared with RFA for refractory SHPT, MWA had a shorter operation time for a single lesion (P < 0.01) and a higher complete ablation rate for a single lesion ≥ 15 mm (P < 0.01) but did not show a difference in the complete ablation rate for a single lesion < 15 mm (P > 0.05). There were no significant differences between MWA and RFA for refractory SHPT concerning parathyroid hormone (P > 0.05), calcium (P > 0.05), and phosphorus levels (P > 0.05) within 12 months after ablation, except that calcium (P < 0.01) and phosphorus levels (P = 0.02) in the RFA group were lower than those in the MWA group at one month after ablation. There was no significant difference between MWA and RFA concerning the cure rate of PHPT (P > 0.05). There were no significant differences between MWA and RFA for PHPT and refractory SHPT concerning the complications of hoarseness (P > 0.05) and hypocalcaemia (P > 0.05).
MWA had a shorter operation time for single lesions and a higher complete ablation rate for large lesions in patients with refractory SHPT. However, there was no significant difference in efficacy and safety between MWA and RFA in cases of both PHPT and refractory SHPT. Both MWA and RFA are effective treatment methods for PHPT and refractory SHPT.
热消融治疗，包括微波消融（MWA）和射频消融（RFA），已被推荐用于原发性甲状旁腺功能亢进症（PHPT）和难治性继发性甲状旁腺功能亢进症（SHPT）的治疗。本荟萃分析旨在评估 MWA 和 RFA 在 PHPT 和难治性 SHPT 患者中的疗效和安全性。
从建库至 2022 年 12 月 5 日，检索 PubMed、EMbase、Cochrane 图书馆、中国知网（CNKI）和万方数据库，纳入比较 MWA 和 RFA 治疗 PHPT 和难治性 SHPT 的研究。采用 Review Manager 软件，版本 5.3 进行数据分析。
共有 5 项研究纳入荟萃分析。其中 2 项为回顾性队列研究，3 项为 RCT。共纳入 294 例 MWA 组患者和 194 例 RFA 组患者。与 RFA 治疗难治性 SHPT 相比，MWA 单次治疗的手术时间更短（P<0.01），单次治疗≥15mm 的完全消融率更高（P<0.01），但单次治疗<15mm 的完全消融率无差异（P>0.05）。MWA 和 RFA 治疗难治性 SHPT 后 12 个月内甲状旁腺激素（P>0.05）、血钙（P>0.05）和血磷（P>0.05）水平无显著差异，仅 RFA 组术后 1 个月血钙（P<0.01）和血磷（P=0.02）水平低于 MWA 组。MWA 和 RFA 治疗 PHPT 的治愈率无显著差异（P>0.05）。MWA 和 RFA 治疗 PHPT 和难治性 SHPT 的并发症发生率，包括声音嘶哑（P>0.05）和低钙血症（P>0.05），无显著差异。
MWA 治疗难治性 SHPT 单次治疗的手术时间更短，大病灶的完全消融率更高。然而，MWA 和 RFA 治疗 PHPT 和难治性 SHPT 的疗效和安全性无显著差异。MWA 和 RFA 均是治疗 PHPT 和难治性 SHPT 的有效方法。
