关键词: 继发性甲状旁腺功能亢进；甲状旁腺全切；前臂皮下种植；胸腺舌叶切除；经济效益

Abstract: Objective To analyze the application effect and economic benefit of total parathyroidectomy(TPTX)+subcutaneous implantation of forearm(AT)+ thymectomy in patients with secondary hyperparathyroidism (SHPT).Methods The clinical data of 110 patients with SHPT who were treated in our hospital from March 2018 to January 2021 were retrospectively analyzed.They were divided into medication group (50 cases,receiving cinacalcet combined with low-dose calcitriol) and operation group (60 cases,receiving TPTX+AT+ thymectomy) according to different treatment regimens.The biochemical indexes,cardiac structure and function,clinical symptoms and quality of life of the two groups were compared before and after treatment for 24 months,and the complications,cost-effectiveness and recurrence rate of the two groups after operation were counted.Results After treatment,the levels of serum iPTH[(206.45±152.59) pg/ml],calcium [(2.05±0.26) mmol/L],phosphorus [(1.48±0.21) mmol/L],calcium-phosphorus product (3.02±0.69) and ALP [(102.03±30.25) U/L] in operation group were all lower Drug group [(721.32±325.36) pg/ml,(2.22±0.18) mmol/L,(1.91±0.22) mmol/L,(4.22±0.74),(140.62±27.15) U/L] (P<0.05);LVEF[(60.85±4.02) %] in operation group was higher than that in drug group [(55.58±3.84) %].LVED[(48.03±2.58) mm] and LVST[(9.85±0.76) mm] were lower than those in drug group [(51.02±3.65) mm,(11.12±0.86) mm](P<0.05).The scores of bone pain,skin pruritus and restless legs syndrome in the operation group were lower than those of the medication group,and the KDTA score was higher than that of the medication group (P<0.05).The total cost of treatment in the operation group [(4.06±1.42) million yuan] was not significantly different from that in the drug group [(3.46±1.85) million yuan] (P>0.05).The effective rate of iPTH reduction in operation group was 90.00%(54/60),which was higher than that in drug group (48.00%,24/50) (P<0.05).The cost-effectiveness analysis showed that the CER of the drug group and the operation group were 7.21 and 4.51 respectively,and the operation treatment had more cost-effectiveness advantages.The incremental cost-effectiveness analysis shows that compared with the drug group,the operation group needs to increase the cost by 14,800 yuan for each additional patient effectively treated for SHPT(P>0.05).There was no significant difference in the incidence of complications (13.33% VS 12.00%) and the recurrence rate (8.33% VS 4.00%) at 24 months after treatment between the operation group and the drug group (P>0.05).Conclusion TPTX+AT+ thymectomy can relieve the bone pain,reduce the iPTH level,correct the disorder of calcium and phosphorus metabolism,improve the heart function and structure,and improve the quality of life,and the cost-effectiveness is higher than SHPT of drug treatment,without increasing short-term recurrence rate.

Key words: secondary hyperparathyroidism；total parathyroidectomy；subcutaneous implantation of the forearm；thymectomy；economic benefits