Department of Otolaryngology-Head and Neck Surgery, North Hospital, Saint-Etienne University Hospital Centre, 42055 Saint-Etienne Cedex 2, France.
Eur Arch Otorhinolaryngol. 2011 Jun;268(6):893-7. doi: 10.1007/s00405-010-1414-9. Epub 2010 Nov 3.
During the past decade, endoscopic video-assisted parathyroidectomy (EP) for primary hyper parathyroidism (PHPT) has gained wider acceptance. The endoscopic gasless procedure described by P. Miccoli (1997-1998) offers an attractive technique. A routine preoperative localization study was performed with both ultrasonography and 99m TC-Sestamibi scintigraphy for each patient with sporadic PHPT. The criteria to select patients eligible for EP included absence of significant nodular goiter, a previous neck surgery, a need for concomitant thyroidectomy, a significant obesity, and multiple enlarged parathyroid glands. The surgical outcome and the use of preoperative localization together with the operative strategy were evaluated. From 2005 to 2009, 59 out of 75 patients (78%) were potentially candidates for this approach. An enlarged parathyroid gland was located by both types of imaging for 34 patients (57%) and by 99 m Tc-Sestamibi scintigraphy for 46 patients (77%). Conversion was required in 11 cases (18%). Nine patients had a negative preoperative imaging study and five underwent a successful EP. The operating time ranged from 35 to 120 min (median 45 min). Usually patients were discharged home at 48 h. There were no cases of permanent hypocalcemia or recurrent laryngeal nerve palsy. Postoperative review showed that all calcium and parathyroid hormone levels remained normal at 3 months except for 1 patient with a double adenoma. EP is a quick, safe, and effective procedure in a selected group of patients. Our results show that this technique can be easily introduced into a general head and neck practice.
在过去的十年中，内镜辅助甲状旁腺切除术（EP）治疗原发性甲状旁腺功能亢进症（PHPT）已被广泛接受。P. Miccoli（1997-1998 年）描述的内镜无气技术提供了一种有吸引力的技术。每位散发性 PHPT 患者均进行术前常规定位研究，包括超声和 99m TC-Sestamibi 闪烁扫描。选择适合 EP 的患者的标准包括无明显结节性甲状腺肿、既往颈部手术史、需要同时进行甲状腺切除术、显著肥胖和多个增大的甲状旁腺。评估了手术结果以及术前定位的使用和手术策略。2005 年至 2009 年，75 例患者中有 59 例（78%）可能适合这种方法。34 例（57%）通过两种成像方法定位增大的甲状旁腺，46 例（77%）通过 99mTc-Sestamibi 闪烁扫描定位。需要转换的有 11 例（18%）。9 例患者术前影像学检查阴性，5 例患者成功进行 EP。手术时间为 35-120 分钟（中位数 45 分钟）。通常患者在 48 小时内出院。无永久性低钙血症或喉返神经麻痹病例。术后复查显示，所有患者的钙和甲状旁腺激素水平在 3 个月内均正常，除 1 例双腺瘤患者外。EP 是一种在选定患者中快速、安全且有效的手术。我们的结果表明，该技术可以很容易地引入到一般的头颈部手术中。
