Alesina P F, Moka D, Mahlstedt J, Walz M K
Clinic of Surgery and Centre of Minimally Invasive Surgery, Kliniken Essen-Mitte, Evang. Huyssens-Stiftung, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Henricistrasse 92, D-45136, Essen, Germany.
World J Surg. 2008 Feb;32(2):224-31. doi: 10.1007/s00268-007-9303-0.
The presence of a mediastinal hyperfunctioning parathyroid gland is a rare condition that occurs in about 1% to 2% of cases. We present our experience with video-endoscopic parathyroidectomy and a review of the literature.
In seven patients (four male, three female; age 28-67 years) mediastinal hyperfunctioning parathyroid glands were removed by the thoracoscopic route (VATS). Six patients suffered from primary hyperpathyroidism and one woman from recurrent secondary hyperparathyroidism. Additionally, articles concerning endoscopic treatment of mediastinal parathyroid glands were collected from the medical databases. A total of 58 patients were found in the English and French literature.
Neither intraoperative nor postoperative complications occurred in our patients. Operating time was 90 minutes (range 40-180 minutes). After a mean follow-up of 29+/-12 months (range 3-64), all patients are biochemically cured. The cases in the literature showed healing in 57 of 58 cases. Their mean operating time was 112 minutes (range 40-240 minutes). One perioperative death due to myocardial infarction and a major complications rate of 7% are described.
The thoracoscopic approach to mediastinal parathyroidectomy is a safe, feasible technique with a low complication rate and good cosmetic outcome. It should become the standard surgical access for mediastinal hyperfunctioning parathyroid glands.
纵隔内功能亢进的甲状旁腺是一种罕见疾病，约占病例的1%至2%。我们介绍了电视内镜甲状旁腺切除术的经验并对文献进行了综述。
7例患者（4例男性，3例女性；年龄28 - 67岁）通过胸腔镜途径（VATS）切除纵隔内功能亢进的甲状旁腺。6例患者患有原发性甲状旁腺功能亢进，1例女性患有复发性继发性甲状旁腺功能亢进。此外，从医学数据库收集了有关纵隔甲状旁腺内镜治疗的文章。在英文和法语文献中总共发现58例患者。
我们的患者术中及术后均未发生并发症。手术时间为90分钟（范围40 - 180分钟）。平均随访29±12个月（范围3 - 64个月）后，所有患者生化指标均恢复正常。文献中的病例58例中有57例治愈。他们的平均手术时间为112分钟（范围40 - 240分钟）。描述了1例围手术期心肌梗死死亡病例，主要并发症发生率为7%。
胸腔镜纵隔甲状旁腺切除术是一种安全、可行的技术，并发症发生率低，美容效果好。它应成为纵隔功能亢进甲状旁腺的标准手术入路。
