Bergenfelz Anders, Lindblom Pia, Tibblin Sten, Westerdahl Johan
Department of Surgery, Lund University Hospital, Lund, Sweden.
Ann Surg. 2002 Nov;236(5):543-51. doi: 10.1097/00000658-200211000-00001.
To compare unilateral and bilateral neck exploration for primary hyperparathyroidism in a prospective randomized controlled trial.
Based on the assumption that unilateral neck exploration for a solitary parathyroid adenoma should reduce operating time and morbidity, a variety of minimally invasive procedures have challenged the idea that bilateral neck exploration is the gold standard for the surgical treatment of primary hyperparathyroidism. However, to date, no open prospective randomized trial has been published comparing unilateral and bilateral neck exploration.
Ninety-one patients with the preoperative diagnosis of primary hyperparathyroidism were randomized to unilateral or bilateral neck exploration. Preoperative scintigraphy and intraoperative parathyroid hormone measurement guided the unilateral exploration. Gross morphology and frozen section determined the extent of parathyroid tissue resection in the bilateral group. The primary end-point was the use of postoperative medication for hypocalcemic symptoms.
Eighty-eight patients (97%) were cured. Histology and cure rate did not differ between the two groups. Patients in the bilateral group consumed more oral calcium, had lower serum calcium values on postoperative days 1 to 4, and had a higher incidence of early severe symptomatic hypocalcemia compared with patients in the unilateral group. In addition, for patients undergoing surgery for a solitary parathyroid adenoma, unilateral exploration was associated with a shorter operative time. The cost for the two procedures did not differ.
Patients undergoing a unilateral procedure had a lower incidence of biochemical and severe symptomatic hypocalcemia in the early postoperative period compared with patients undergoing bilateral exploration. Unilateral neck exploration with intraoperative parathyroid hormone assessment is a valid surgical strategy in patients with primary hyperparathyroidism with distinct advantages, especially for patients with solitary parathyroid adenoma.
在一项前瞻性随机对照试验中比较单侧和双侧颈部探查术治疗原发性甲状旁腺功能亢进症的效果。
基于单侧颈部探查孤立性甲状旁腺腺瘤应能减少手术时间和发病率这一假设，多种微创术式对双侧颈部探查是原发性甲状旁腺功能亢进症外科治疗金标准这一观点提出了挑战。然而，迄今为止，尚无比较单侧和双侧颈部探查术的开放性前瞻性随机试验发表。
91例术前诊断为原发性甲状旁腺功能亢进症的患者被随机分为接受单侧或双侧颈部探查术。术前闪烁扫描和术中甲状旁腺激素测量指导单侧探查。大体形态和冰冻切片确定双侧组甲状旁腺组织切除范围。主要终点是术后使用药物治疗低钙血症症状。
88例患者（97%）治愈。两组间组织学和治愈率无差异。与单侧组患者相比，双侧组患者口服钙消耗量更多，术后第1至4天血清钙值更低，早期严重症状性低钙血症发生率更高。此外，对于接受孤立性甲状旁腺腺瘤手术的患者，单侧探查术的手术时间更短。两种手术的费用无差异。
与接受双侧探查术的患者相比，接受单侧手术的患者术后早期生化性和严重症状性低钙血症的发生率更低。术中进行甲状旁腺激素评估的单侧颈部探查术是原发性甲状旁腺功能亢进症患者有效的手术策略，具有明显优势，尤其是对于孤立性甲状旁腺腺瘤患者。
