Tibblin S, Bizard J P, Bondeson A G, Bonjer J, Bruining H A, Meier F, Proye C, Quievreux J L, Rothmund M, Thompson N W
Department of Surgery, University Hospitals, Ann Arbor, Mich.
Eur J Surg. 1991 Sep;157(9):511-5.
Surgical regimens for treatment of solitary parathyroid adenoma were compared in a multicentre study in five departments of surgery in the United States and Europe. Three hundred and twenty-five patients fulfilled the inclusion criteria. Eight years after the operation 272 patients (84%) were available for follow-up investigation. Severe postoperative hypocalcaemia (less than 2.00 mmol) was significantly more common after bilateral than unilateral exploration (p less than 0.001), and in women (p less than 0.01). Neither age nor preoperative serum calcium concentration was related to the severity of postoperative hypocalcaemia. At follow-up, 96% of the patients who had had unilateral, and 89% of those who had had Bilateral exploration had remained normocalcaemic without further treatment. Of the patients who had had incisional biopsies of normal glands 8% had hypercalcaemia and 8% had hypocalcaemia. Of patients operated on without a biopsy being taken or who had had one whole normal gland removed 1% were hypercalcaemic and 4% were hypocalcaemic. Early and late hypocalcaemia are reduced by atraumatic handling of the normal parathyroid gland without increasing the risk of persistent or recurrent hypercalcaemia.
美国和欧洲五个外科科室开展了一项多中心研究，比较了治疗孤立性甲状旁腺腺瘤的手术方案。325例患者符合纳入标准。术后八年，272例患者（84%）可接受随访调查。双侧探查术后严重低钙血症（低于2.00 mmol）比单侧探查更为常见（p<0.001），且在女性中更常见（p<0.01）。年龄和术前血清钙浓度均与术后低钙血症的严重程度无关。随访时，接受单侧探查的患者中有96%、接受双侧探查的患者中有89%在未接受进一步治疗的情况下血钙仍保持正常。接受正常腺体切开活检的患者中，8%出现高钙血症，8%出现低钙血症。未进行活检或切除了整个正常腺体的手术患者中，1%出现高钙血症，4%出现低钙血症。通过对正常甲状旁腺进行无创伤处理可减少早期和晚期低钙血症，且不会增加持续性或复发性高钙血症的风险。
