Department of Thoracic Surgery, Medical University of Lublin, Lublin, Poland.
Ann Thorac Surg. 2010 Jun;89(6):1750-5. doi: 10.1016/j.athoracsur.2010.02.076.
Recent publications have recommended parathyroidectomy guided solely by preoperative imaging. However, when the parathyroid adenoma is located deep in the mediastinum, the surgeon often encounters difficulties to localize and completely remove all hyperfunctioning parathyroid tissues. Thus, we hypothesized that patients with mediastinal adenoma differ substantially from cervical cases and require a specific strategy. The aim of this study was to evaluate the efficacy of intraoperative serum parathyroid hormone monitoring (ioPTH) used to guide completeness of targeted mediastinal parathyroidectomy.
In a 10-year period, 33 patients underwent targeted mediastinal parathyroidectomy with ioPTH for primary sporadic hyperparathyroidism. A greater than 50% drop in ioPTH was considered confirming successful resection. If ioPTH failed to decline adequately, the operation was extended to complete cervical exploration. We analyzed the impact of ioPTH on the final surgical outcome.
In 26 patients the adenoma was correctly identified and removed at targeted mediastinal parathyroidectomy. In 7 patients lack of adequate ioPTH drop after targeted mediastinal parathyroidectomy triggered continued exploration, providing success at complete cervical exploration in 6 patients. In 1 patient this strategy failed owing to an undiagnosed lesion in the posterior mediastinum. Use of ioPTH decreased the failure rate from a potential 21.2% without ioPTH to 3% in the actual series.
Mediastinal parathyroid adenoma represents a distinct subset of primary hyperparathyroidism and requires a specific diagnostic and therapeutic approach. In these cases ioPTH monitoring is a reliable and effective method to confirm curative resection. It is an important adjunct predictor of postoperative successful outcome, which allows a low failure rate and avoids unnecessary reoperations.
最近的出版物建议仅根据术前影像学进行甲状旁腺切除术。然而，当甲状旁腺腺瘤位于纵隔深部时，外科医生通常难以定位并完全切除所有功能亢进的甲状旁腺组织。因此，我们假设纵隔腺瘤患者与颈部病例有很大不同，需要特定的策略。本研究旨在评估术中甲状旁腺激素监测（ioPTH）用于指导靶向纵隔甲状旁腺切除术完整性的效果。
在 10 年期间，33 例患有原发性散发性甲状旁腺功能亢进症的患者接受了靶向纵隔甲状旁腺切除术和 ioPTH。ioPTH 下降大于 50%被认为是成功切除的确认。如果 ioPTH 下降不足，手术将扩展到完整的颈部探查。我们分析了 ioPTH 对最终手术结果的影响。
在 26 例患者中，腺瘤在靶向纵隔甲状旁腺切除术时被正确识别并切除。在 7 例患者中，靶向纵隔甲状旁腺切除术后 ioPTH 下降不足导致持续探查，6 例患者在完全颈部探查中取得成功。在 1 例患者中，由于后纵隔未诊断的病变，该策略失败。使用 ioPTH 将潜在的无 ioPTH 失败率从 21.2%降低到实际系列中的 3%。
纵隔甲状旁腺腺瘤是原发性甲状旁腺功能亢进症的一个独特亚组，需要特定的诊断和治疗方法。在这些情况下，ioPTH 监测是一种可靠且有效的方法，可以确认治愈性切除。它是术后成功结果的重要辅助预测因子，可以降低失败率并避免不必要的再次手术。
