Haciyanli M, Genc H, Damburaci N, Oruk G, Tutuncuoglu P, Erdogan N
Ataturk Training and Research Hospital, Second Surgery, Izmir, Turkey.
J Postgrad Med. 2009 Oct-Dec;55(4):242-6. doi: 10.4103/0022-3859.58925.
Minimally invasive parathyroidectomy (MIP) is widely used worldwide for the treatment of primary hyperparathyroidism (pHPT). It is usually combined with a perioperative adjunct for high success rate.
To demonstrate that MIP can be successfully performed in a selected group of patients with presumabally solitary adenoma as the cause of pHPT without using any perioperative adjuncts.
A prospective data analysis of two surgeons' series from a teaching hospital in Turkey.
Of the 47 patients referred with a diagnosis of pHPT during January 2004-May 2008, 30(63%) patients with sporadic pHPT with presumed solitary adenoma were included for analysis. These patients underwent MIP via focused lateral (n=24) or anterior (n=6) approach. Preoperative localization was done using 99 mTc-labelled sestamibi scan and ultrasonography. Only patients with concordant tests for single adenoma were selected for MIP. Serum parathyroid hormone and calcium levels were measured postoperatively and at follow-up visits.
Parametric data presented were analyzed with Excel XP (Microsoft, Redmond, WA, USA).
Barring one patient, all other patients were initially biochemically cured by MIP. One patient remained hypercalcemic, who was found to have a second adenoma at the second operation. During a mean follow-up of 16 (3-55) months, all patients were normocalcemic with a mean serum calcium level of 9.4 (8.9-10.2) mg/dl. Parathormone levels were persistantly elevated only in one patient (3.4%). No postoperative permanent complication was encountered.
The results of MIP achieved in high-volume endocrine surgery centers can be replicated in low-volume center without any intraoperative adjuncts, in patients with overt clinical pHPT and concordant results of sestamibi and ultrasound.
微创甲状旁腺切除术（MIP）在全球范围内广泛用于治疗原发性甲状旁腺功能亢进症（pHPT）。它通常与围手术期辅助手段联合使用以提高成功率。
证明在一组推测为孤立性腺瘤导致pHPT的特定患者中，不使用任何围手术期辅助手段也能成功进行MIP。
对土耳其一家教学医院两位外科医生的系列病例进行前瞻性数据分析。
在2004年1月至2008年5月期间转诊诊断为pHPT的47例患者中，纳入30例（63%）推测为孤立性腺瘤的散发性pHPT患者进行分析。这些患者通过聚焦外侧入路（n = 24）或前入路（n = 6）接受MIP。术前定位采用99mTc标记的甲氧基异丁基异腈扫描和超声检查。仅选择对单一腺瘤检查结果一致的患者进行MIP。术后及随访时测量血清甲状旁腺激素和钙水平。
所呈现的参数数据用Excel XP（美国华盛顿州雷德蒙德市微软公司）进行分析。
除1例患者外，所有其他患者最初通过MIP实现生化治愈。1例患者血钙仍高，在第二次手术时发现有第二个腺瘤。在平均16（3 - 55）个月的随访期间，所有患者血钙正常，平均血清钙水平为9.4（8.9 - 10.2）mg/dl。仅1例患者（3.4%）甲状旁腺激素水平持续升高。未遇到术后永久性并发症。
在临床明显的pHPT且甲氧基异丁基异腈和超声检查结果一致的患者中，高容量内分泌外科中心所取得的MIP结果可以在低容量中心不使用任何术中辅助手段的情况下复制。
