Bergenfelz A, Algotsson L, Ahrén B
Department of Surgery, Lund University, Sweden.
Br J Surg. 1992 Sep;79(9):931-4. doi: 10.1002/bjs.1800790926.
Patients with primary hyperparathyroidism are often elderly with cardiovascular disease and in some an operation might be hazardous owing to anaesthetic complications. A technique for operation for primary hyperparathyroidism under local anaesthesia is described. The method uses a unilateral approach. Seventeen consecutive patients operated on under local anaesthesia were compared with a group of 15 patients undergoing surgery under general anaesthesia. Normocalcaemia was achieved in 14 patients in each group. There was no difference in the extent of pain or the overall well-being between the two groups as determined by a visual analogue scale. Patients receiving local anaesthesia, however, experienced significantly less nausea after operation (P < 0.01). There was more fluctuation in blood pressure and heart rate in the general anaesthesia group compared with the other group. Surgery for primary hyperparathyroidism can be performed safely under local anaesthesia, and could be offered to patients if general anaesthesia were not suitable or involved an increased perioperative risk. It should not be recommended for routine use in patients who are fit for general anaesthesia.
原发性甲状旁腺功能亢进症患者多为老年人，常伴有心血管疾病，在某些情况下，手术可能因麻醉并发症而具有危险性。本文描述了一种在局部麻醉下进行原发性甲状旁腺功能亢进症手术的技术。该方法采用单侧入路。将连续17例在局部麻醉下接受手术的患者与一组15例接受全身麻醉手术的患者进行比较。两组各有14例患者血钙恢复正常。通过视觉模拟评分法测定，两组在疼痛程度或总体健康状况方面没有差异。然而，接受局部麻醉的患者术后恶心明显较少（P < 0.01）。与另一组相比，全身麻醉组的血压和心率波动更大。原发性甲状旁腺功能亢进症手术在局部麻醉下可以安全进行，如果全身麻醉不适合或围手术期风险增加，可以为患者提供局部麻醉。对于适合全身麻醉的患者，不建议常规使用局部麻醉。
