Geipel D, Wendt F, Weiss M L, Mischke W, Lössner C
Chirurgische Klinik, Klinikum Berlin-Buch, Bundesrepublik Deutschland.
Zentralbl Chir. 1991;116(16):951-9.
We report on 14 patients suffering from persistent (n = 13) and truly recurrent (n = 1) primary hyperparathyroidism. Reoperations were successful in 13 cases. Cervical reexploration was only required for 5 patients who had previous operations by unexperienced surgeons in other clinics. In 5 out of 7 patients operated by us, the causes of the persistent primary hyperparathyroidism were 4 adenomas and one hyperplastic gland in the mediastinum found by median sternotomy. The remaining cases were a rare ectopic location of the inferior glands and an inadequate resection in four-gland-hyperplasia. Preoperative localization procedures were carried out for most patients. 201-Tl/99m-Tc-subtraction scintigraphy has proved for localization in both the cervical region and the mediastinum to be a highly sensitive method. Reoperative parathyroid surgery can be reduced with thorough initial cervical exploration by experienced surgeons in specialized clinics.
我们报告了14例患有持续性（n = 13）和真正复发性（n = 1）原发性甲状旁腺功能亢进症的患者。再次手术在13例中成功。仅5例先前在其他诊所由经验不足的外科医生进行过手术的患者需要进行颈部再次探查。在我们手术的7例患者中，有5例持续性原发性甲状旁腺功能亢进症的病因是通过正中胸骨切开术发现的4个腺瘤和1个纵隔增生性腺。其余病例为罕见的下位腺体异位和四腺增生切除不充分。大多数患者进行了术前定位检查。201铊/99m锝减影闪烁显像已被证明是一种在颈部区域和纵隔定位中高度敏感的方法。在专业诊所，由经验丰富的外科医生进行彻底的初始颈部探查，可以减少再次甲状旁腺手术。
