Impact of Surgical Parathyroidectomy on Craniofacial Morphology in Patients With Renal Failure.

IF 1 4区医学 Q3 SURGERY

American Surgeon Pub Date : 2025-01-01 Epub Date: 2024-08-08 DOI:10.1177/00031348241272425

Zhenpeng Liao, Zhongkang Ye, Xu Zhang, Jun Zhang, Peng He, Haiyu Hong, Jiaoping Mi

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引用次数: 0

Abstract

Purpose: Parathyroidectomy is beneficial in tertiary hyperparathyroidism (THPT) consequent to chronic renal failure. The craniofacial morphology of patients who undergo total parathyroidectomy and autologous transplantation (tPTX + AT) has not been widely studied. This study assessed the efficacy of tPTX + AT in THPT and evaluated possible improvements in craniofacial features.

Methods: This retrospective analysis included patients who were diagnosed with medically refractory THPT and had undergone tPTX + AT between September 2013 and May 2021. The VAS was used to evaluate improvements in various symptoms including bone pain and pruritus. Changes in serum calcium, phosphorus, alkaline phosphatase, and intact parathyroid hormone (iPTH) levels were also assessed. The impact of the procedure was assessed by comparing two-photon X-ray bone mineral density measurements obtained 1 year before and after surgery.

Results: The VAS of pain and pruritus decreased significantly on the first postoperative day (P < 0.05). Calcium levels changed significantly (from 2.50 ± 0.22 mmol/L to 2.10 ± 0.26 mmol/L) on postoperative day 1 (P = 0.0000); iPTH levels also declined substantially on this day, reducing from 211.00 (122.10, 252.80) to 5.04 (2.96, 9.40) pmol/L. Bone mineral density increased significantly across various regions including the greater trochanter of the femur, intertrochanteric area, total hip, and third lumbar vertebra (P < 0.05). The angles between the upper incisor and mandibular plane and the lower lip and Ricketts E line (drawn from the tip of the nose to the soft tissue area) also improved (P = 0.043, P = 0.001).

Conclusion: Total parathyroidectomy and autologous transplantation can rapidly alleviate bone pain and skin itching in THPT. It may also improve bone density and facial soft tissue.

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甲状旁腺切除手术对肾衰竭患者颅面形态的影响

目的：甲状旁腺切除术对慢性肾功能衰竭导致的三级甲状旁腺功能亢进症（THPT）有益。对接受甲状旁腺全切除术和自体移植（tPTX + AT）的患者的颅面形态尚未进行广泛研究。本研究评估了甲状旁腺全切除术和自体移植（tPTX + AT）对甲状旁腺功能衰竭的疗效，并评估了颅面特征可能得到的改善：这项回顾性分析纳入了2013年9月至2021年5月期间被诊断为药物难治性THPT并接受了tPTX+AT治疗的患者。采用 VAS 评估骨痛和瘙痒等各种症状的改善情况。此外，还评估了血清钙、磷、碱性磷酸酶和完整甲状旁腺激素（iPTH）水平的变化。通过比较手术前后一年的双光子 X 射线骨矿密度测量结果，评估了手术的影响：结果：术后第一天，疼痛和瘙痒的 VAS 显著下降（P < 0.05）。钙水平在术后第1天有明显变化（从2.50 ± 0.22 mmol/L降至2.10 ± 0.26 mmol/L）（P = 0.0000）；iPTH水平在这一天也大幅下降，从211.00 (122.10, 252.80) pmol/L降至5.04 (2.96, 9.40) pmol/L。包括股骨大转子、转子间区、全髋和第三腰椎在内的各个区域的骨矿物质密度都有明显增加（P < 0.05）。上切牙与下颌平面之间的角度以及下唇与里克特E线（从鼻尖到软组织区域）之间的角度也有所改善（P = 0.043，P = 0.001）：结论：甲状旁腺全切除术和自体移植可迅速缓解THPT患者的骨痛和皮肤瘙痒。结论：甲状旁腺全切除术和自体移植能迅速缓解THPT患者的骨痛和皮肤瘙痒，还能改善骨密度和面部软组织。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Surgeon 医学-外科

CiteScore

1.40

自引率

0.00%

发文量

623

期刊介绍： The American Surgeon is a monthly peer-reviewed publication published by the Southeastern Surgical Congress. Its area of concentration is clinical general surgery, as defined by the content areas of the American Board of Surgery: alimentary tract (including bariatric surgery), abdomen and its contents, breast, skin and soft tissue, endocrine system, solid organ transplantation, pediatric surgery, surgical critical care, surgical oncology (including head and neck surgery), trauma and emergency surgery, and vascular surgery.