Beyer Todd D, Solorzano Carmen C, Starr Fred, Nilubol Naris, Prinz Richard A
Rush University Medical Center, Chicago, IL, USA.
Am J Surg. 2007 Mar;193(3):368-72; discussion 372-3. doi: 10.1016/j.amjsurg.2006.09.023.
Parathyroidectomy for primary sporadic hyperparathyroidism (psHPT) has evolved with advances in preoperative gland localization and intraoperative parathyroid hormone (ioPTH) monitoring to minimally invasive approaches (MIPS).
Two hundred twenty patients underwent parathyroidectomy for psHPT. Forty-nine patients underwent bilateral neck exploration (BNE) (group 1), 60 patients underwent BNE with ioPTH monitoring (group 2), and 111 patients underwent MIPS with ioPTH monitoring (group 3).
At 3 months postoperatively, mean serum calcium and intact parathyroid hormone (PTH) levels were similar between groups, and eucalcemia rates were 100%, 100%, and 99%. The ultimate rates of persistent disease and recurrence were also similar. Operative time was shorter in group 3 compared to group 2 (P < .001) but not group 1. Frozen sections and patient charges were significantly lower in group 3 compared to groups 1 and 2 (P < .005).
Parathyroidectomy for psHPT is highly successful with these techniques. When a MIPS approach can be done, it is potentially quicker and associated with lower patient charges.
随着术前腺体定位和术中甲状旁腺激素（ioPTH）监测技术的进步，原发性散发性甲状旁腺功能亢进症（psHPT）的甲状旁腺切除术已发展为微创方法（MIPS）。
220例患者接受了psHPT的甲状旁腺切除术。49例患者接受双侧颈部探查（BNE）（第1组），60例患者接受BNE并进行ioPTH监测（第2组），111例患者接受MIPS并进行ioPTH监测（第3组）。
术后3个月，各组间血清钙和完整甲状旁腺激素（PTH）的平均水平相似，血钙正常率分别为100%、100%和99%。持续性疾病和复发的最终发生率也相似。第3组的手术时间比第2组短（P <.001），但与第1组相比无差异。与第1组和第2组相比，第3组的冰冻切片和患者费用显著降低（P <.005）。
采用这些技术，psHPT的甲状旁腺切除术非常成功。当可以采用MIPS方法时，手术可能更快，且患者费用更低。
