Department of Digestive, Hepatobiliary, and Endocrine Surgery, CHU Nancy-Brabois (Hopital Adultes), University of Nancy, 11 allée du morvan, 54511 Vandoeuvre-les-Nancy, France.
Langenbecks Arch Surg. 2010 Sep;395(7):935-40. doi: 10.1007/s00423-010-0687-1. Epub 2010 Aug 6.
Several new minimally invasive techniques (mini-open, video-assisted, and endoscopic procedures) for parathyroidectomy have been described. However, totally endoscopic lateral approach parathyroidectomy (Henry technique) is not routinely performed.
This is a prospective study of 200 consecutive patients that underwent totally endoscopic lateral parathyroidectomy.
Two hundred of 387 patients (52%) with primary hyperparathyroidism were included. Fifty-six patients (28%) were converted to open parathyroidectomy. Causes for conversion were lack of intraoperative localization (11%), difficult dissection (10%), bleeding (4%), failure of normalization of IOPTH results (2%), and other causes (1%). Gland localization (areas 1 to 2 versus area 3) and CaPTHus score (<3 versus ≥3) were not associated with the risk of conversion. Mean postoperative follow-up was 13 months, and 196 patients (98%) were cured.
Totally endoscopic lateral approach can be proposed in more than half of the patients with good immediate results. Conversion rate remains important and may explain low acceptance rate of this technique.
已经描述了几种新的微创技术（微创、视频辅助和内窥镜手术）用于甲状旁腺切除术。然而，完全内窥镜侧入路甲状旁腺切除术（Henry 技术）并未常规进行。
这是一项对 200 例连续接受完全内窥镜侧甲状旁腺切除术的患者进行的前瞻性研究。
387 例原发性甲状旁腺功能亢进症患者中，有 200 例（52%）被纳入研究。56 例（28%）患者转为开放性甲状旁腺切除术。转为开放性手术的原因包括术中定位缺失（11%）、难以分离（10%）、出血（4%）、IOPTH 结果未正常化（2%）和其他原因（1%）。腺体定位（1 区至 2 区与 3 区）和 CaPTHus 评分（<3 与≥3）与转换风险无关。平均术后随访 13 个月，196 例（98%）患者治愈。
对于大多数患者来说，完全内窥镜侧入路可获得良好的即刻效果。转换率仍然很重要，这可能解释了该技术低接受率的原因。
