Politz Douglas, Norman James
Norman Endocrine Surgery Clinic, Tampa, Florida 33613, USA.
Thyroid. 2007 Apr;17(4):333-9. doi: 10.1089/thy.2006.0259.
Parathyroid surgery in elderly patients is commonly delayed due to perceived high operative risk. We evaluated the presentation of patients over 80 with primary hyperparathyroidism (PHPT) and their ability to tolerate outpatient, minimally invasive parathyroidectomy.
We conducted a prospective cohort study of 150 consecutive patients over the age of 80 for the treatment of sporadic, nonfamilial PHPT. Presenting symptoms were compiled by questionnaire and compared between male and female (32 males, 118 females) and to 2600 patients under the age of 80. All patients underwent minimally invasive parathyroidectomy and were discharged from the recovery room. Operative findings and outcomes were assessed.
97% reported at least one symptom--the majority had five or more. The most common symptoms were fatigue, hypertension, and memory problems (occurring in 62%, 62%, and 57% of patients, respectively). Symptoms were similar between men and women, with the exception of bone pain being twice as common in women and kidney stones being twice as common in men (both p < 0.05). Preoperative calcium and parathyroid hormone (PTH) levels as well as the frequency of each symptom closely paralleled those of patients less than 80 years old with no significant differences. Average operative time was 18 +/- 5 minutes with discharge averaging 1.9 +/- 0.2 hours later. The incidence of single adenoma, double adenoma, or hyperplasia was identical to patients less than 80 (p = NS). Two patients required rehospitalization within 30 days of the procedure (congestive heart failure and pulmonary embolism), neither one for hypocalcemia. There were no deaths, and the cure rate was 99.3%.
PHPT is similar symptomatically, biochemically, and histopathologically between patients > 80 years old and younger patients. Modern techniques allow for small incisions, quick operative times, outpatient discharge, and uneventful recovery. Patients over 80 years old tolerate outpatient parathyroidectomy without event.
由于认为手术风险高，老年患者的甲状旁腺手术通常会延迟。我们评估了80岁以上原发性甲状旁腺功能亢进症（PHPT）患者的临床表现及其耐受门诊微创甲状旁腺切除术的能力。
我们对150例连续的80岁以上患者进行了前瞻性队列研究，以治疗散发性、非家族性PHPT。通过问卷调查收集症状表现，并在男性和女性（32例男性，118例女性）之间进行比较，并与2600例80岁以下患者进行比较。所有患者均接受了微创甲状旁腺切除术，并从恢复室出院。评估手术结果和转归。
97%的患者报告至少有一种症状——大多数患者有五种或更多症状。最常见的症状是疲劳、高血压和记忆问题（分别发生在62%、62%和57%的患者中）。男性和女性的症状相似，但骨痛在女性中出现的频率是男性的两倍，肾结石在男性中出现的频率是女性的两倍（均p<0.05）。术前钙和甲状旁腺激素（PTH）水平以及每种症状的发生频率与80岁以下患者密切相似，无显著差异。平均手术时间为18±5分钟，出院平均时间为1.9±0.2小时后。单发腺瘤、双发腺瘤或增生的发生率与80岁以下患者相同（p=无显著性差异）。两名患者在手术后30天内需要再次住院（充血性心力衰竭和肺栓塞），均非因低钙血症。无死亡病例，治愈率为99.3%。
80岁以上患者与年轻患者在PHPT的症状、生化和组织病理学方面相似。现代技术允许小切口、快速手术时间、门诊出院和平稳恢复。80岁以上患者能够耐受门诊甲状旁腺切除术且无不良事件发生。
