Del Rio P, Bezer L, Palladino S, Arcuri M F, Iotti E, Sianesi M
Department of Surgical Science, University of Parma, Italy.
G Chir. 2010 Apr;31(4):155-8.
Mininvasive surgical techniques have been proposed to treat the patients affected by parathyroid adenoma starting by endoscopically-assisted parathyroidectomy up to video-assisted and radio-guided approaches.
Our technique, minimally invasive video-assisted parathyroidectomy (MIVAP), in accord with Miccoli's technique, has been introduced in our center since 2006 after extensive experience with MIVAT (minimally invasive videoassisted thyroidectomy). From September 2006 to October 2008 we performed 32 MIVAP on 32 patients, 21 female and 11 males with a mean age of 53.4 years (range 25-77) affected by parathyroid adenoma. Patients have been divided in two groups in chronological order: Group A included the first 15 patients, Group B the second ones.
Mean operative time from incision to skin closure has been 47.4+/-14.2 minutes for group A and 34+/-10.3 minutes for group B (p<0.01). Postoperative pain, scored from 0 to 10 evaluated at time 0 and after 24 hours from the procedure, has been of 2.6+/-0.5 and 1.4+/-0.5 in group A (p<0.001) while in group B of 2.58+/-0.51 and 1.16+/-0.38 (p<0.001) respectively. The difference in postoperative pain was not significant between the two groups and the pain was controlled by the administration of paracetamol 1 g. On the other side, the comparison between postoperative pain in patients operated via traditional bilateral cervical exploration and MIVAP (2.61+/-0.5 vs 3.55+/-0.51 and 1.38+/-0.5 vs 2.16+/-0.61 at 0 and 24 hours respectively), was statistically significant (p<0.001) and in favour of MIVAP.
We showed a shorter operative time between the A group and B group. 15 cases are sufficient as good learning curve if the surgeon is experienced in videoassisted neck procedure. The postoperative pain is lower in videoassisted procedure than cervical bilateral approach.
已经提出了微创外科技术来治疗甲状旁腺腺瘤患者,从内镜辅助甲状旁腺切除术到视频辅助和放射性引导方法。
自2006年以来,在积累了丰富的MIVAT(微创视频辅助甲状腺切除术)经验后,我们中心引入了与米科利技术一致的我们的技术,即微创视频辅助甲状旁腺切除术(MIVAP)。从2006年9月至2008年10月,我们对32例受甲状旁腺腺瘤影响的患者进行了32例MIVAP手术,其中女性21例,男性11例,平均年龄53.4岁(范围25 - 77岁)。患者按时间顺序分为两组:A组包括前15例患者,B组为后15例患者。
A组从切口到皮肤缝合的平均手术时间为47.4±14.2分钟,B组为34±10.3分钟(p<0.01)。在手术结束时0小时和术后24小时评估的术后疼痛,A组分别为2.6±0.5和1.4±0.5(p<0.001),而B组分别为2.58±0.51和1.16±0.38(p<0.001)。两组之间术后疼痛差异不显著,通过给予1克对乙酰氨基酚可控制疼痛。另一方面,经传统双侧颈部探查手术的患者与MIVAP患者术后疼痛的比较(分别在0小时和24小时时为2.61±0.5 vs 3.55±0.51和1.38±0.5 vs 2.16±0.61)具有统计学意义(p<0.001),且有利于MIVAP。
我们发现A组和B组之间手术时间更短。如果外科医生有视频辅助颈部手术的经验,15例病例就足以形成良好的学习曲线。视频辅助手术的术后疼痛低于颈部双侧手术。