Department of Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France.
Ann Surg. 2010 Apr;251(4):717-21. doi: 10.1097/SLA.0b013e3181c1cfb0.
To retrospectively evaluate the feasibility of thoracoscopic removal of mediastinal parathyroids.
Mediastinal exploration to resect ectopic parathyroid(s) is needed in approximately 2% of cases in hyperparathyroidism. Recent advances in thoracoscopic surgery allow for a minimally invasive treatment.
From 1999 through 2007, 13 patients affected by primary hyperparathyroidism (11 females, mean age 60 years, range: 22-88) underwent thoracoscopic removal of mediastinal parathyroids. Scintigraphy produced positive results in 11 of 13 cases, computed tomography scan in 9 of 10, parathyroid hormone venous sampling in 10 of 10 patients, and magnetic resonance imaging in 5 of 7. Right thoracoscopic access was used in 9 patients, left in 4. Postoperative outcome was analyzed.
Thoracoscopy enabled retrieval of mediastinal parathyroids in 10 of 13 (78%) cases. Mean operating time was 92 minutes (range: 50-240). One procedure (8%) was converted. No perioperative deaths/major complications occurred. Mild complications occurred in 2 of 13 (15%) patients (pneumothorax/pneumonia, transient recurrent nerve palsy). Mean hospital stay was 4.7 days (range: 2-15). At a mean follow-up of 73 months (range: 16-105), parathyroid hormone and calcium venous concentrations were high in 3 patients. Unsuccessful procedures were related to doubtful or non-concordant preoperative localization.
The thoracoscopic approach for mediastinal parathyroidectomy is feasible and safe. An accurate preoperative work-up should be standardized to avoid useless procedures. In case of negative preoperative localization of the abnormal gland, thoracoscopy should not be adopted as a diagnostic tool.
回顾性评估胸腔镜切除纵隔甲状旁腺的可行性。
在甲状旁腺功能亢进症中，约有 2%的病例需要进行纵隔探查以切除异位甲状旁腺。胸腔镜手术的最新进展允许进行微创治疗。
1999 年至 2007 年，13 例原发性甲状旁腺功能亢进症患者（11 例女性，平均年龄 60 岁，范围：22-88 岁）接受了胸腔镜纵隔甲状旁腺切除术。13 例中有 11 例放射性核素扫描结果阳性，10 例 CT 扫描结果阳性，10 例甲状旁腺激素静脉取样结果阳性，7 例 MRI 扫描结果阳性。9 例采用右侧胸腔镜入路，4 例采用左侧入路。分析术后结果。
胸腔镜能够在 13 例中的 10 例（78%）中取出纵隔甲状旁腺。平均手术时间为 92 分钟（范围：50-240 分钟）。1 例（8%）手术中转。无围手术期死亡/重大并发症发生。13 例中有 2 例（15%）患者出现轻度并发症（气胸/肺炎，短暂性喉返神经麻痹）。平均住院时间为 4.7 天（范围：2-15 天）。在平均 73 个月（范围：16-105 个月）的随访中，3 例患者甲状旁腺激素和钙静脉浓度升高。手术不成功与术前定位不确定或不一致有关。
胸腔镜纵隔甲状旁腺切除术是可行和安全的。应标准化术前检查以避免不必要的手术。如果异常腺体的术前定位为阴性，则不应将胸腔镜作为诊断工具。
