| Objective To observe the clinical efficacy of total parathyroidectomy with forearm autograft (PTX+AT) on severe secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD). Methods A total of 20 patients with refractory SHPT, who received the operation of PTX+AT in our hospital from February 2011 to July 2012 and had been followed-up for more than 3months, were selected. The changes of serum iPTH, calcium, phosphorus, hemoglobin, and related clinical symptom were observed before and after the operation. Results The operations of all the 20 patients were performed successfully. Eighteen patients received total PTX+AT, while the remaining 2 patients had 3 parathyroids found and removed during operations and without forearm autograft. No surgical complications such as laryngeal nerve damage, dyspnea, or twitch occurred. Clinical symptom including bone pain, skin pruritus, and fatigue of all the patients were alleviated at the 2nd day after operation. The concentrations of serum iPTH, calcium, and phosphate after operation decreased obviously (P<0.05). Hct increased significantly 3 months later after the operation (P<0.05). Conclusion Total PTX+AT has certain efficacy on refractory SHPT in patients with CKD. It has been proved to be a safe, economical, and effective method. Accurate locating of the parathyroid before the operation and timely adjustment of serum calcium after the operation is crucial for the success of the treatment. |