Ultrasound-guided microwave ablation for secondary hyperparathyroidism: a systematic review and meta-analysis

Microwave ablation (MWA) is used for the treatment of severe secondary hyperparathyroidism (SHPT), but its efficacy and safety still remained unclear. This study aimed to investigate the efficacy and safety of ultrasound (US)-guided MWA in patients with SHPT. The PubMed, Cochrane library, Embase, China national knowledge infrastructure (CNKI) and Wanfang databases were searched to identify published studies that evaluated the efficacy and safety of US-guided MWA in patients with SHPT. The primary outcomes were parathyroid hormone (PTH), serum calcium and phosphorus levels. A total of 26 studies with 932 patients were identified. The PTH levels showed significant reduction at 1 month [weighted mean difference (WMD) = 945.33, 95% CI: 797.15∼1093.52] and 6 months (WMD = 1,151.91, 95% CI: 990.93∼1312.89) after MWA of SHPT patients. The serum calcium (WMD = 0.39, 95% CI: 0.30 ∼ 0.48) and phosphorus levels (WMD = 0.64, 95% CI: 0.43 ∼ 0.85) showed significant reduction at 6 months after MWA of SHPT patients. The most common complications observed were hypocalcemia (35.2%) and transient hoarseness (9.2%). No other major complications or death occurred in our study patients. These findings suggest MWA as a safe and effective minimally invasive technique for the management of SHPT. PTH, calcium, and phosphorus levels were significantly reduced at 1 and 6 months after MWA.

微波消融（microwave ablation, MWA）曾被应用于重症继发性甲状旁腺功能亢进症（secondary hyperparathyroidism, SHPT）的治疗，但其疗效与安全性迄今仍不明确。本研究旨在探讨超声（ultrasound, US）引导下MWA治疗SHPT患者的疗效与安全性。研究人员检索了PubMed、Cochrane图书馆、Embase、中国知网（China National Knowledge Infrastructure, CNKI）及万方数据库，以筛选评估超声引导下MWA治疗SHPT患者疗效与安全性的已发表研究。本研究的主要结局指标为甲状旁腺激素（parathyroid hormone, PTH）、血清钙及血清磷水平。最终共纳入26项相关研究，涉及932例患者。SHPT患者接受MWA治疗后1个月[加权均数差（weighted mean difference, WMD）=945.33，95%置信区间（confidence interval, CI）：797.15~1093.52]及6个月[WMD=1151.91，95%CI：990.93~1312.89]，其PTH水平均显著降低。治疗后6个月时，SHPT患者的血清钙[WMD=0.39，95%CI：0.30~0.48]及血清磷[WMD=0.64，95%CI：0.43~0.85]水平均显著下降。本研究中观察到的最常见并发症为低钙血症（35.2%）与短暂性声嘶（9.2%）。本研究纳入的患者未出现其他严重并发症或死亡病例。本研究结果表明，MWA是一种安全有效的微创治疗手段，可用于SHPT的临床管理。SHPT患者接受MWA治疗后1个月及6个月时，其PTH、血清钙及血清磷水平均显著降低。