Coman Adina, Tarta Cristi, Aiordachioae Gigi Adrian, Goldis Dan, Utu Diana, Marian Marco, Dobrescu Amadeus, Buleu Florina, Olariu Sorin
Researching Future Surgery II Research Center, Department X, Discipline of General Surgery II, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania.
Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania.
J Clin Med. 2025 Jul 12;14(14):4944. doi: 10.3390/jcm14144944.
: Secondary hyperparathyroidism (SHPT) is a prevalent complication in end-stage renal disease, often necessitating surgical intervention when refractory to medical therapy. The optimal surgical strategy-subtotal parathyroidectomy (SPTX) versus total parathyroidectomy with/without autotransplantation (TPTX ± AT)-remains debated, especially considering postoperative complications like persistent HPT and hungry bone syndrome (HBS). This study aimed to compare early surgical outcomes and identify predictors for postoperative complications in patients undergoing SPTX and TPTX + AT. : We conducted a retrospective, single-center observational study involving 93 dialysis patients who underwent PTX for drug-refractory SHPT. Patients were analyzed according to surgical procedure (SPTX vs. TPTX + AT), focusing on postoperative complications such as cervical bleeding, reintervention rates, and the incidence of HBS. Multivariate logistic regression was utilized to identify predictors of these outcomes. : TPTX + AT demonstrated superior control of HPT, with significantly lower rates of reintervention compared to SPTX (7.1% vs. 23.5%, = 0.037). However, TPTX + AT was associated with a higher incidence of HBS (57.1% vs. 35.3%, = 0.039). Independent predictors of reintervention included absence of concomitant thymectomy, preoperative hypercalcemia, fewer visualized glands preoperatively, and preoperative PTH > 2000 pg/mL. Elevated alkaline phosphatase levels (>300 U/L), severe bone pain, and the TPTX procedure itself were significant predictors of HBS. : Surgical strategy for SHPT should be individualized, balancing the lower recurrence risk associated with TPTX + AT against its higher likelihood of postoperative hypocalcemia. Preoperative biochemical markers and clinical features could potentially influence operative decision-making and optimize patient outcomes.
继发性甲状旁腺功能亢进（SHPT）是终末期肾病中一种常见的并发症，当药物治疗无效时通常需要手术干预。最佳手术策略——甲状旁腺次全切除术（SPTX）与甲状旁腺全切除术加/不加自体移植（TPTX±AT）——仍存在争议，尤其是考虑到术后并发症，如持续性甲状旁腺功能亢进和饥饿骨综合征（HBS）。本研究旨在比较早期手术结果，并确定接受SPTX和TPTX + AT的患者术后并发症的预测因素。
我们进行了一项回顾性、单中心观察性研究，纳入了93例因药物难治性SHPT接受甲状旁腺切除术的透析患者。根据手术方式（SPTX与TPTX + AT）对患者进行分析，重点关注术后并发症，如颈部出血、再次干预率和HBS的发生率。采用多变量逻辑回归来确定这些结果的预测因素。
TPTX + AT对甲状旁腺功能亢进的控制效果更佳，与SPTX相比，再次干预率显著更低（7.1%对23.5%，P = 0.037）。然而，TPTX + AT与更高的HBS发生率相关（57.1%对35.3%，P = 0.039）。再次干预的独立预测因素包括未同时进行胸腺切除术、术前高钙血症、术前可见腺体较少以及术前甲状旁腺激素>2000 pg/mL。碱性磷酸酶水平升高（>300 U/L）、严重骨痛和TPTX手术本身是HBS的显著预测因素。
SHPT的手术策略应个体化，权衡TPTX + AT较低的复发风险与其术后低钙血症较高的可能性。术前生化指标和临床特征可能会影响手术决策并优化患者预后。
