Clark O H, Wilkes W, Siperstein A E, Duh Q Y
Department of Surgery, University of California, San Francisco.
J Bone Miner Res. 1991 Oct;6 Suppl 2:S135-42; discussion 151-2. doi: 10.1002/jbmr.5650061428.
Several recent articles question whether patients with asymptomatic hyperparathyroidism and minimal hypercalcemia should be treated by parathyroidectomy. We therefore reviewed our experience in 103 consecutive patients with primary hyperparathyroidism who were treated by parathyroidectomy to determine, first, how many of these patients had asymptomatic or symptomatic hyperparathyroidism, and second, did these patients benefit from parathyroidectomy? We also analyzed the safety of parathyroidectomy in 426 consecutive patients, including 79 who required reoperation for hyperparathyroidism, specifically looking for complications and the outcome of these procedures. Our study documents the following: (1) only 2 of 103 (2%) patients referred for parathyroidectomy had "true" asymptomatic hyperparathyroidism; (2) only symptoms of fatigue, bone pain, and weight loss correlated with the degree of hypercalcemia, whereas muscular weakness, psychiatric symptoms, nocturia, polyuria, recent memory loss, constipation, and nephrolithiasis did not; (3) only 1 of 15 patients who were referred as asymptomatic were truly asymptomatic after more thorough questioning, and all 14 improved following parathyroidectomy; (4) 81% of the patients who were referred with symptoms improved following parathyroidectomy; and (5) permanent complications occurred in only 4 patients. All but 1 had reoperations for persistent or recurrent hyperparathyroidism (3 vocal cord paralyses and 1 hypoparathyroidism requiring autotransplantation of cryopreserved parathyroid tissue). There was 1 death of an 84-year-old woman with hypercalcemic crisis. Thus, most patients with hyperparathyroidism are symptomatic and benefit symptomatically and metabolically from parathyroidectomy, which is a safe operation.
最近的几篇文章对无症状性甲状旁腺功能亢进和轻度高钙血症患者是否应接受甲状旁腺切除术提出了质疑。因此，我们回顾了103例连续接受甲状旁腺切除术治疗的原发性甲状旁腺功能亢进患者的经验，首先确定这些患者中有多少患有无症状或有症状的甲状旁腺功能亢进，其次确定这些患者是否从甲状旁腺切除术中获益。我们还分析了426例连续患者甲状旁腺切除术的安全性，其中79例因甲状旁腺功能亢进需要再次手术，特别关注这些手术的并发症和结果。我们的研究记录如下：（1）103例接受甲状旁腺切除术的患者中只有2例（2%）患有“真正的”无症状性甲状旁腺功能亢进；（2）只有疲劳、骨痛和体重减轻的症状与高钙血症程度相关，而肌肉无力、精神症状、夜尿症、多尿症、近期记忆力减退、便秘和肾结石则无关；（3）15例被转诊为无症状的患者中，经过更全面的询问后只有1例真正无症状，所有14例在甲状旁腺切除术后均有改善；（4）81%有症状转诊的患者在甲状旁腺切除术后症状改善；（5）仅4例出现永久性并发症。除1例因持续性或复发性甲状旁腺功能亢进再次手术外（3例声带麻痹和1例甲状旁腺功能减退需要冷冻保存的甲状旁腺组织自体移植）。有1例84岁患有高钙血症危象的女性死亡。因此，大多数甲状旁腺功能亢进患者有症状，并且从甲状旁腺切除术中在症状和代谢方面获益，该手术是安全的。
