Sukumar Mithran S, Komanapalli Christopher B, Cohen James I
Department of Surgery, Division of Cardiothoracic Surgery, OR Health and Science University, Portland, Oregon 97239, USA.
Laryngoscope. 2006 Mar;116(3):482-7. doi: 10.1097/01.mlg.0000200582.65418.37.
INTRODUCTION/METHODS: Traditional surgical management of mediastinal parathyroid adenomas has required mediastinal exploration via sternotomy or thoracotomy. By contrast minimal access approaches to the mediastinum via videoscopic transthoracic or transcervical approaches can offer equivalent visualization, patient safety and decreased patient morbidity. The availability of sternal retractor systems, the rapid parathyroid hormone (PTH) assay for intraoperative confirmation of cure, recurrent laryngeal nerve monitoring technique and video-assisted thoracic surgery (VATS) instrumentation have made this possible. The purpose of this article is to discuss these approaches and the results with their application in five consecutive patients.
Five consecutive patients underwent mediastinal exploration of which three were performed transcervically and three transthoracically (one patient underwent both procedures). One patient had a negative thoracic exploration; one patient's course was complicated by transient recurrent laryngeal nerve injury which resolved spontaneously.
Transcervical approaches for resection of anterior mediastinal parathyroid adenomas are possible with the use of the Rultract Skyhook Retractor without the need for sternotomy. VATS provides excellent visualization of the middle and posterior mediastinum avoiding the morbidity of thoracotomy.
引言/方法：传统的纵隔甲状旁腺腺瘤手术治疗需要通过胸骨切开术或开胸术进行纵隔探查。相比之下，通过电视胸腔镜经胸或经颈入路的纵隔微创入路能够提供同等的视野、患者安全性并降低患者发病率。胸骨牵开系统的可用性、用于术中确认治愈的快速甲状旁腺激素（PTH）检测、喉返神经监测技术以及电视辅助胸腔手术（VATS）器械使得这一切成为可能。本文旨在讨论这些入路及其在连续5例患者中的应用结果。
连续5例患者接受了纵隔探查，其中3例经颈进行，3例经胸进行（1例患者接受了两种手术）。1例患者胸腔探查结果为阴性；1例患者的病程因短暂性喉返神经损伤而复杂化，但该损伤自行缓解。
使用Rultract Skyhook牵开器可以经颈入路切除前纵隔甲状旁腺腺瘤，而无需进行胸骨切开术。VATS能够很好地观察中纵隔和后纵隔，避免了开胸术的并发症。
