Refractory Secondary Hyperparathyroidism in Xinjiang: A Retrospective Cohort Study on the Efficacy and Safety of Radiofrequency Ablation versus Parathyroidectomy

Secondary hyperparathyroidism (SHPT) is a common and severe complication in maintenance hemodialysis patients. In the Xinjiang region, the prevention and management of this disease face unique challenges due to geographical, dietary, and healthcare resource characteristics. For patients with drug-refractory SHPT, surgical intervention is the primary treatment. Traditional parathyroidectomy (PTX) is effective but invasive, with a high risk of complications. In recent years, ultrasound-guided radiofrequency ablation (RFA) has emerged as a minimally invasive treatment option, garnering increasing attention. This study aims to systematically compare the comprehensive efficacy and safety of RFA versus PTX in treating patients with refractory SHPT in Xinjiang, providing evidence for developing individualized management strategies.

This single-center retrospective cohort study consecutively enrolled 97 patients with refractory SHPT who were diagnosed and underwent surgical treatment at the People's Hospital of Xinjiang Uygur Autonomous Region between January 2021 and December 2024. Based on the surgical procedure received, patients were divided into an RFA group (n=31) and a PTX group (n=66). Clinical data were comprehensively collected from electronic medical records and evaluated across four dimensions: 1) Biochemical Efficacy: Dynamic monitoring and comparison of intact parathyroid hormone (iPTH), serum calcium, serum phosphorus, and alkaline phosphatase levels preoperatively and at 1 day, 2 days, 3 days, 1 month, 3 months, and 6 months postoperatively. 2) Perioperative Indicators: Detailed recording and analysis of operation time, postoperative hospital stay, and total hospitalization costs. 3) Safety: Meticulous tracking and recording of postoperative complications, including symptomatic hypocalcemia, recurrent laryngeal nerve injury (permanent and temporary), hematoma, and infection. 4) Long-term Outcomes: Recording and comparison of biochemical recurrence within 6 months postoperatively. Statistical analysis was performed using SPSS 26.0, with measurement data analyzed by t-test or Mann-Whitney U test, and count data by χ² test or Fisher's exact test.

Regarding biochemical efficacy, iPTH levels significantly improved at all postoperative time points compared to preoperative levels in both groups (P<0.01). The PTX group showed a significantly greater decrease in iPTH in the early postoperative period (1-3 days) than the RFA group (P<0.05). The decline in the RFA group was relatively gradual, but by 3 and 6 months postoperatively, there was no statistically significant difference in the iPTH达标率 (achievement rate) between the two groups (P>0.05). In terms of safety, the RFA group demonstrated a clear advantage, with a total complication rate of 12.9% (4/31), significantly lower than the 29.9% in the PTX group (P<0.05). Notably, the incidence of symptomatic hypocalcemia was markedly higher in the PTX group (36.4%) compared to only 6.5% in the RFA group (P<0.01). Regarding nerve injury, the PTX group had 3 cases (4.5%) of permanent recurrent laryngeal nerve injury, while the 2 cases (6.5%) of transient hoarseness in the RFA group completely resolved within 3 months. For perioperative indicators, the RFA group had significantly shorter operation times and postoperative hospital stays than the PTX group (P<0.01), but there was no significant difference in total hospitalization costs between the groups (P>0.05). Regarding long-term outcomes, during the 6-month follow-up period, biochemical recurrence occurred in 3 cases (9.7%) in the RFA group and 2 cases (3.0%) in the PTX group.

For patients with refractory SHPT in the Xinjiang region, both radiofrequency ablation (RFA) and parathyroidectomy (PTX) are effective treatment options. PTX demonstrates a stronger and more rapid effect in reducing iPTH and may have a lower long-term recurrence rate. In contrast, RFA, with its minimally invasive advantages, excels in significantly reducing the risk of severe complications (especially symptomatic hypocalcemia and permanent nerve injury) and shortening operation and recovery times. Therefore, clinical decision-making should be individualized, based on the patient's specific condition, tolerance for surgical risk, and treatment expectations. RFA can be a preferred minimally invasive option for specific patients, particularly the elderly, those with multiple comorbidities, or those apprehensive about traditional surgery.