Slepavicius Algirdas, Beisa Virgilijus, Janusonis Vinsas, Strupas Kestutis
Klaipeda University Hospital, Liepojos 41, Klaipeda, 92288, Lithuania.
Langenbecks Arch Surg. 2008 Sep;393(5):659-66. doi: 10.1007/s00423-008-0408-1. Epub 2008 Aug 15.
For many years bilateral neck exploration (BNE) was the gold standard operation for primary hyperparathyroidism (pPHP). With advances in preoperative pathological gland localization and intraoperative parathyroid hormone (IPTH) monitoring, minimally invasive approaches have evolved. This study is aimed to compare BNE and focused parathyroidectomy (FP) in a prospective, randomized, blind trial.
Between 2005 and 2007, 48 patients with pPHP were enrolled in our study. Twenty three patients were randomized to the BNE group and 24 to the FP group. Patients in the FP group underwent preoperative localization studies. All parathyroidectomies were guided by intraoperative intact parathyroid hormone (IIPTH) monitoring. In the BNE group, neither IIPTH nor preoperative localization studies were performed.
All patients were cured by the primary operation. Overall, the operative time was similar in both groups. In the focused exploration (FE) group, compared to the BNE group, there was lower pain intensity at 4, 8, 16, 24, 36 and 48 h after surgery (p < 0.001), lower consumption of analgesics (p < 0.001), lower analgesia request rate (p < 0.001), shorter scar length (p < 0.001), higher cosmetic satisfaction rate 2 days, 1 month (p < 0.001) and 6 months after surgery (p < 0.05), but after 1 year cosmetic satisfaction rate became not significant (p = 0.38). Focused exploration (FE) was more expensive (p < 0.05). We did not find any difference in quality of life after 1 month and 6 months after surgery in both groups.
Both methods of parathyroidectomy for PHP are safe and effective. Focused exploration (FE) has several advantages: lower postoperative pain, lower analgesic request rate, lower analgesic consumption, shorter scar length, better cosmetic satisfaction rate in a short time period.
多年来，双侧颈部探查术（BNE）一直是原发性甲状旁腺功能亢进症（pPHP）的金标准手术。随着术前病变腺体定位和术中甲状旁腺激素（IPTH）监测技术的进步，微创方法不断发展。本研究旨在通过一项前瞻性、随机、盲法试验比较BNE和聚焦甲状旁腺切除术（FP）。
2005年至2007年期间，48例pPHP患者纳入本研究。23例患者随机分为BNE组，24例患者随机分为FP组。FP组患者术前行定位检查。所有甲状旁腺切除术均在术中完整甲状旁腺激素（IIPTH）监测引导下进行。BNE组既未进行IIPTH监测，也未进行术前定位检查。
所有患者均通过初次手术治愈。总体而言，两组手术时间相似。在聚焦探查（FE）组，与BNE组相比，术后4、8、16、24、36和48小时疼痛强度更低（p < 0.001），镇痛药消耗量更低（p < 0.001），镇痛需求率更低（p < 0.001），瘢痕长度更短（p < 0.001），术后2天、1个月（p < 0.001）和6个月（p < 0.05）美容满意度更高，但术后1年美容满意度差异无统计学意义（p = 0.38）。聚焦探查（FE）费用更高（p < 0.05）。两组术后1个月和6个月的生活质量无差异。
两种治疗PHP的甲状旁腺切除术方法均安全有效。聚焦探查（FE）有几个优点：术后疼痛更低、镇痛需求率更低、镇痛药消耗量更低、瘢痕长度更短、短期内美容满意度更高。
