Udelsman R, Donovan P I, Sokoll L J
Departments of Surgery and Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Ann Surg. 2000 Sep;232(3):331-9. doi: 10.1097/00000658-200009000-00005.
To review the outcomes of 100 consecutive minimally invasive parathyroid explorations.
Minimally invasive parathyroidectomy (MIP) has challenged the traditional approach of bilateral neck exploration for patients with primary hyperparathyroidism. Most patients with primary hyperparathyroidism have a single adenoma that when resected results in cure. It therefore appears logical to perform a directed approach to adenoma extirpation. MIP involves high-quality sestamibi images obtained with single photon emission computed tomography to localize enlarged parathyroid glands in three dimensions, limited exploration after surgeon-administered cervical block anesthesia, rapid intraoperative parathyroid hormone assay to confirm the adequacy of resection, and discharge within 1 to 3 hours of surgery.
MIP was offered to 100 selected consecutive patients during an 18-month period beginning in March 1998.
Ninety-two cases were accomplished under cervical block anesthesia and 89 of these on an ambulatory basis. The cure rate was 100%, and there were no long-term complications. The mean hospital charge for MIP was less than 40% of that associated with traditional exploration.
Outpatient MIP appears to be the procedure of choice for most patients with primary hyperparathyroidism.
回顾连续100例微创甲状旁腺探查术的结果。
微创甲状旁腺切除术（MIP）对原发性甲状旁腺功能亢进患者传统的双侧颈部探查方法提出了挑战。大多数原发性甲状旁腺功能亢进患者有单个腺瘤，切除后可治愈。因此，采用定向方法切除腺瘤似乎是合理的。MIP包括通过单光子发射计算机断层扫描获得高质量的锝[99mTc]甲氧基异丁基异腈图像，以三维定位增大的甲状旁腺，在外科医生实施颈部阻滞麻醉后进行有限的探查，术中快速测定甲状旁腺激素以确认切除是否充分，并在手术1至3小时内出院。
从1998年3月开始的18个月期间，为连续100例选定患者实施MIP。
92例在颈部阻滞麻醉下完成，其中89例为门诊手术。治愈率为100%，无长期并发症。MIP的平均住院费用不到传统探查术的40%。
门诊MIP似乎是大多数原发性甲状旁腺功能亢进患者的首选手术方式。
