Richards Melanie L, Thompson Geoff B, Farley David R, Grant Clive S
Mayo Clinic, Department of Surgery, Rochester, MN, USA.
Am J Surg. 2008 Dec;196(6):937-42; discussion 942-3. doi: 10.1016/j.amjsurg.2008.07.022.
Reoperative parathyroidectomy (R-PTX) in primary hyperparathyroidism (1HPT) has increased failure rates and morbidity. This study evaluated R-PTX during the era of minimal-access PTX with intraoperative parathyroid hormone (IOPTH) monitoring.
Two thousand sixty-five patients with 1HPT who underwent PTX were assessed for R-PTX. Preoperative studies, operative findings, and outcomes were evaluated.
Two hundred twenty-eight patients underwent 236 R-PTX procedures. Imaging performed included sestamibi (89%), ultrasound (US; 56%), computed axial tomography/magnetic resonance imaging (5%), and selective venous sampling (1%). Sestamibi was more sensitive than US (84% vs 68%). Curative surgery was performed in 89% of patients. IOPTH was 99% sensitive. There was no relationship between cure and the following parameters: preoperative calcium or PTH levels, persistent or recurrent disease, or use of IOPTH. Solitary gland disease and a single previous operation were associated with increased likelihood of cure (P = .06). Hypoparathyroidism was decreased using IOPTH monitoring (2% vs 9%). One patient had recurrent laryngeal nerve palsy.
R-PTX can be performed effectively with minimal complications. IOPTH is an accurate predictor of cure and may decrease the frequency of permanent hypoparathyroidism.
原发性甲状旁腺功能亢进症（1HPT）再次手术甲状旁腺切除术（R-PTX）的失败率和发病率有所增加。本研究评估了在微创甲状旁腺切除术时代并采用术中甲状旁腺激素（IOPTH）监测的R-PTX。
对2065例行甲状旁腺切除术的1HPT患者进行R-PTX评估。对术前检查、手术发现和结果进行评估。
228例患者接受了236次R-PTX手术。所进行的影像学检查包括锝[99mTc]甲氧基异丁基异腈（89%）、超声（US；56%）、计算机断层扫描/磁共振成像（5%）和选择性静脉采血（1%）。锝[99mTc]甲氧基异丁基异腈比超声更敏感（84%对68%）。89%的患者接受了根治性手术。IOPTH的敏感性为99%。治愈与以下参数之间无相关性：术前血钙或甲状旁腺激素水平、持续性或复发性疾病或IOPTH的使用。孤立性腺疾病和既往单次手术与治愈可能性增加相关（P = 0.06）。使用IOPTH监测可降低甲状旁腺功能减退症的发生率（2%对9%）。1例患者发生喉返神经麻痹。
R-PTX可有效进行，并发症极少。IOPTH是治愈的准确预测指标，可能会降低永久性甲状旁腺功能减退症的发生率。
