Monchik Jack M, Barellini Leonardo, Langer Peter, Kahya Arif
Division of Endocrine Surgery, Rhode Island Hospital and Brown University School of Medicine, Providence, RI, USA.
Surgery. 2002 May;131(5):502-8. doi: 10.1067/msy.2002.123853.
Parathyroid surgery for sporadic primary hyperparathyroidism (pHPT) can be accomplished with local/regional anesthesia and intraoperative monitoring of intact parathyroid hormone without exclusion criteria through a 1.0- to 1.25-inch (2.5- to 3.2-cm) incision (MIPL) in a high proportion of patients.
One hundred thirty-one consecutive patients with pHPT were offered MIPL. One hundred three patients elected to have this procedure. Patients were not excluded because of inadequate localization, previous parathyroid surgery, or need for concomitant thyroid surgery. Preoperative localization with ultrasound and/or sestamibi-single photon emission computed tomography scan was done in all patients. Almost all patients had intraoperative monitoring of intact parathyroid hormone (IMPTH).
MIPL was accomplished in 89 of these 103 patients (86.4%), but 14 required conversion to general anesthesia. The main reasons for conversion were concomitant thyroid surgery, no positive preoperative localization, and previous parathyroid surgery. This procedure was accomplished in 13 patients requiring a bilateral procedure, 5 patients requiring thyroid surgery, 4 patients with no positive preoperative localization, and in 3 patients with previous parathyroid surgery. The complications of MIPL were comparable to the traditional bilateral exploration with general anesthesia. No patient experienced permanent hypoparathyroidism or postoperative bleeding. Two patients had transient recurrent laryngeal nerve paresis, and surgery failed to correct hypercalcemia in 5 (4.9%) of the patients. There appears to be less need for antiemetic medication in the MIPL patients compared with patients who had general anesthesia.
Parathyroid surgery for sporadic pHPT can be accomplished through a 1.0- to 1.25-inch (2.5- to 3.2-cm) incision with local/regional anesthesia, without exclusion criteria. Accurate preoperative localization, particularly localization to the same site by both ultrasound and 99mTc-sestamibi scan, and IMPTH can limit the surgery to a unilateral approach. One should be cautious in proceeding with MIPL in patients with need for concomitant thyroid surgery, no preoperative localization, or previous parathyroid surgery.
对于散发性原发性甲状旁腺功能亢进症（pHPT），甲状旁腺手术可在局部/区域麻醉下进行，并在术中监测完整甲状旁腺激素，通过1.0至1.25英寸（2.5至3.2厘米）的切口（微创甲状旁腺切除术，MIPL）在很大比例的患者中完成，且无排除标准。
连续131例pHPT患者被提供MIPL手术。103例患者选择接受该手术。患者不因定位不充分、既往甲状旁腺手术或需要同期进行甲状腺手术而被排除。所有患者均进行了术前超声和/或锝-99m甲氧基异丁基异腈单光子发射计算机断层扫描定位。几乎所有患者均进行了术中完整甲状旁腺激素监测（IMPTH）。
这103例患者中有89例（86.4%）完成了MIPL，但14例需要转为全身麻醉。转为全身麻醉的主要原因是同期甲状腺手术、术前定位无阳性结果以及既往甲状旁腺手术。该手术在13例需要双侧手术的患者、5例需要甲状腺手术的患者、4例术前定位无阳性结果的患者以及3例既往有甲状旁腺手术的患者中完成。MIPL的并发症与传统全身麻醉下的双侧探查相当。没有患者发生永久性甲状旁腺功能减退或术后出血。2例患者出现短暂性喉返神经麻痹，5例（4.9%）患者手术未能纠正高钙血症。与接受全身麻醉的患者相比，MIPL患者似乎较少需要使用止吐药物。
散发性pHPT的甲状旁腺手术可通过1.0至1.25英寸（2.5至3.2厘米）的切口在局部/区域麻醉下完成，且无排除标准。准确的术前定位，特别是超声和99mTc-甲氧基异丁基异腈扫描均定位至同一部位，以及IMPTH可将手术限制为单侧入路。对于需要同期进行甲状腺手术、术前无定位或既往有甲状旁腺手术的患者，进行MIPL时应谨慎。
