Prager G, Czerny C, Kurtaran A, Passler C, Scheuba C, Bieglmayer C, Niederle B
Division of General Surgery, Department of Surgery, University of Vienna, Medical School, Währinger Guertel 18-20, A-1090 Wien, Austria.
Arch Surg. 2001 Jul;136(7):810-6. doi: 10.1001/archsurg.136.7.810.
Single-gland disease identified by preoperative localization studies in combination with rapid intraoperative parathyroid hormone monitoring seems to allow a limited exploration of the neck in sporadic primary hyperparathyroidism. Minimally invasive open parathyroidectomy by lateral approach (oMIP) in sporadic primary hyperparathyroidism seems feasible in an endemic goiter region.
One hundred consecutive patients with sporadic primary hyperparathyroidism underwent preoperative double-phase technetium Tc 99m sestamibi scanning with single-photon emission computed tomography and high-resolution ultrasonography with color Doppler imaging of the cervical region. All patients were operated on with the use of quick parathyroid hormone assay to confirm the surgical success "on-line." Patients with localized single-gland disease, irrespective of additional ipsilateral thyroid disease requiring surgery, were selected for oMIP. Success of the preoperative localization studies, postoperative (at least 6 months) serum calcium levels, and operating time were analyzed.
University hospital, section of endocrine surgery.
Of 100 patients, 83 (83%) were considered suitable for oMIP. In 69 patients, oMIP was finished successfully. Nine of these had had previous neck surgery, and another 24 underwent additional ipsilateral thyroid resection. Permanent normocalcemia was achieved in 67 (97.1%) of 69 patients and 98 (98%) of 100 patients.
The oMIP in combination with quick parathyroid hormone assay may become the treatment of choice for sporadic primary hyperparathyroidism in an endemic goiter region in centers with high experience in thyroid and parathyroid surgery. It allows treatment of concomitant ipsilateral thyroid disease and is feasible in reoperations.
术前定位研究结合术中快速甲状旁腺激素监测所识别的单腺体疾病，似乎能在散发性原发性甲状旁腺功能亢进症中进行有限的颈部探查。在地方性甲状腺肿地区，采用外侧入路的微创开放性甲状旁腺切除术（oMIP）治疗散发性原发性甲状旁腺功能亢进症似乎是可行的。
连续100例散发性原发性甲状旁腺功能亢进症患者接受了术前双期锝Tc 99m甲氧基异丁基异腈扫描及单光子发射计算机断层扫描，以及颈部彩色多普勒成像的高分辨率超声检查。所有患者均采用快速甲状旁腺激素检测进行手术，以“在线”确认手术成功。选择患有局限性单腺体疾病的患者进行oMIP，无论其同侧是否存在需要手术的甲状腺疾病。分析术前定位研究的成功率、术后（至少6个月）血清钙水平和手术时间。
大学医院，内分泌外科。
100例患者中，83例（83%）被认为适合进行oMIP。69例患者成功完成了oMIP。其中9例曾接受过颈部手术，另外24例接受了同侧甲状腺切除术。69例患者中有67例（97.1%）以及100例患者中有98例（98%）实现了永久性血钙正常。
在甲状腺和甲状旁腺手术经验丰富的中心，oMIP结合快速甲状旁腺激素检测可能成为地方性甲状腺肿地区散发性原发性甲状旁腺功能亢进症的首选治疗方法。它可以治疗同侧伴随的甲状腺疾病，并且在再次手术中是可行的。
