Objective: To establish bipolar RFA for controlling secondary hyperparathyroidism(SHPT) in uremia and assess the technical feasibility, safety and preliminary clinical efficacy.
Methods: 19 patients with a mean hemodialysis duration of 11.7±3.92 years and a mean serum PTH value of 3263.8±1528.56 pg/ml underwent bi-polar RFA for their 49 enlarged parathyroid glands under CEUS guidance. An isolating zone formed by injection of lidocaine solution into the inter-space between parathyroid and recurrent laryngeal nerve aimed to protect the nerve from heating injury. Decline extent of PTH value and enhancement of ablated glands on CEUS post to RFA were all documented together with percutaneous biopsy histology performed on partial cases.
Results: CEUS demonstrated that all the ablated enlarged parathyroids turned out to be fully non-enhanced while hyper-enhanced before RFA, in accordance with the microscopic findings of complete necrosis. RFA gave rise to marked decline in serum PTH value, with a mean scale of 41.09±17.09% significantly larger than that from calcitriol pulse therapy(-5.31±23.25%, P<0.005). All the patients felt inspiring improvement in their knee joint rigidity, back pain and itch skin.
Conclusions: RFA with use of Celon ProBreath electrode is convenient and safe for confidential destroying parathyroid tissue. This method works much more effectively to make elevated serum PTH drop back to normal range and patients’ symptoms diminish. Chance for recurrent laryngeal nerve being injured decrease. Hypocalcemia after RFA should be followed closely and corrected in time.