Norman Parathyroid Center, Wesley Chapel-Tampa, Florida 33544, USA.
Otolaryngol Head Neck Surg. 2011 Jun;144(6):867-71. doi: 10.1177/0194599811400366. Epub 2011 Mar 4.
It has been taught that a missing parathyroid adenoma can be within the thyroid. Therefore, thyroid lobectomy is appropriate when an adenoma cannot be found. Unfortunately, this technique is often futile. The purpose of this study is to examine the frequency of unsuccessful thyroid lobectomy in parathyroid surgery and to look at the true incidence and location of intrathyroid parathyroid adenomas (iT-PAs).
A retrospective chart review of 11,163 patients undergoing parathyroid surgery identifying the location of more than 40,000 parathyroid glands.
A tertiary care center specializing in parathyroid surgery.
A total of 1163 reoperations for persistent primary hyperparathyroidism (PHPT) were examined for the incidence and outcomes of thyroid lobectomy performed to find iT-PA. A second study examined 10,000 patients undergoing first-time parathyroidectomy to classify the location and incidence of iT-PA.
Thyroid lobectomy had been previously unsuccessfully performed in 77% cases of PHPT undergoing reoperation. Two or fewer glands were found in 82% prior to lobectomy. The adenoma was subsequently found on the lobectomy side in 64% and on the opposite side in 36%. True iT-PA occurred in only 0.7% of 10,000 primary cases. Another 1.2% were closely adherent to or partially within the thyroid substance. The most common location was the lower lateral quadrant of the thyroid.
The incidence of true iT-PA is less than 1%, occurring in predictable locations. Thyroid lobectomy for a missing parathyroid adenoma is typically unsuccessful and should only rarely, if ever, be performed.
人们一直认为甲状旁腺腺瘤可能位于甲状腺内。因此，当无法找到腺瘤时，甲状腺叶切除术是合适的。不幸的是，这种技术通常是徒劳的。本研究的目的是检查甲状旁腺手术中甲状腺叶切除术不成功的频率，并研究甲状腺内甲状旁腺腺瘤（iT-PA）的真实发生率和位置。
对 11163 例行甲状旁腺手术的患者进行回顾性图表审查，确定了 40000 多个甲状旁腺的位置。
专门从事甲状旁腺手术的三级保健中心。
共检查了 1163 例持续性原发性甲状旁腺功能亢进症（PHPT）的再次手术，以研究为寻找 iT-PA 而行甲状腺叶切除术的发生率和结果。第二项研究检查了 10000 例首次甲状旁腺切除术患者，以对 iT-PA 的位置和发生率进行分类。
在接受再次手术的 PHPT 患者中，77%的患者之前曾行甲状腺叶切除术，但未成功。82%的患者在叶切除术前发现有 2 个或更少的腺体。随后，腺瘤在 64%的叶切除侧发现，在 36%的对侧发现。在 10000 例原发性病例中，真正的 iT-PA 仅发生在 0.7%。另有 1.2%的病例紧密附着或部分位于甲状腺实质内。最常见的位置是甲状腺下外侧象限。
真正的 iT-PA 的发生率小于 1%，发生在可预测的位置。对于缺失的甲状旁腺腺瘤，甲状腺叶切除术通常是不成功的，应极少进行，如有必要。
