Abstract: Objective To analyze the short and long- term effects of the three parathyroidectomy (PTX) methods in the treatment of chronic kidney diseases patients with secondary hyperparathyroidism (SHPT). Methods A total of 425 SHPT patients treated with one of the three PTX methods were analyzed. Before the operation and after the operation for one week, 3 months, one years and 4 years, the data about serum intact parathyroid hormone (iPTH), calcium, phosphorus, alkaline phosphatase, clinical symptoms, postoperative complications and relapse were collected. Results PTX was successfully operated in all of the patients. After
the operation, symptoms such as bone pain, skin itching, myasthenia gravis, restless legs symptoms relieved significantly. Shrinkage of body height ceased in 53 cases with shrinking men syndrome, and facial deformities stopped progressing in 35 cases with Sagliker syndrome. Walking by themselves gradually became possible after the operation for one year in 30 cases with severe skeletal deformities and inability to walk. Serum iPTH decreased significantly (1802.602 ± 5.418 pg/ml vs. 25.838±0.190 pg/ml, F=24.526, P=0.000) after the operation for one week. Serum iPTH remained at low levels for a long time, and maintained at 62.120±0.096 pg/ml after the operation for 4 years. There were no statistical differences among the 3 PTX methods in shortterm successful rate (χ2=2.655, P=0.265), mortality (χ2=2.548, P=0.280), prevalence of hypocalcemia in one week after the operation (χ2=0.066, P=0.968), relapse rate in one year after the operation (χ2=0.236, P=0.889), and relapse rate in 4 years after the operation (χ2=0.616, P=0.735). For long-term evaluation of PTX effects, the prevalence of higher serum iPTH was more in patients after subtotal PTX than those after total PTX with or without autologous parathyroid transplantation (χ2=20.525, P=0.000), and mortality was higher in those with higher serum iPTH. Conclusions PTX is a safe and effective therapeutic method for chronic kidney diseases patients with refractory SHPT. Serum iPTH level is more stable in patients undergoing total PTX with or without autologous parathyroid transplantation than in those treated with subtotal parathyroidectomy. After PTX, serum iPTH, calcium and phosphorus can be maintained at reasonable ranges for a long time.

Key words: Chronic kidney diseases, Parathyroidectomy, Secondary Hyperparathyroidism