Division of Cardiothoracic Surgery, Duke University Hospital, Durham, North Carolina, USA.
Ann Thorac Surg. 2011 Sep;92(3):1012-7. doi: 10.1016/j.athoracsur.2011.04.091.
Patients with refractory hyperparathyroidism after neck exploration may have a mediastinal parathyroid gland that has not been identified reliably with a single radiologic study. We report 17 patients who underwent minimally invasive resection for mediastinal parathyroid adenomas after confirmatory multipoint radiologic imaging.
Fifteen patients underwent thoracoscopic procedures and 2 patients underwent mediastinoscopic procedures for resection of suspected mediastinal parathyroid adenoma. Preoperative localizing studies included sestamibi scan, computed tomography scan of the neck and chest, and selective venous sampling of parathyroid hormone levels. Once a mediastinal location was determined, thoracoscopic or mediastinoscopic resection was performed. Successful removal of parathyroid tissue was confirmed with a 50% or greater reduction in intraoperative parathyroid hormone levels.
Parathyroid adenoma was resected in 88% of patients after the operation. The cure rate was 100% in patients with two or more concordant studies locating parathyroid tissue in the mediastinum and 60% in those with one positive study. The thoracostomy tube was removed on median postoperative day 1 (range, 0 to 2 days). Median hospital stay was 3 days (range, 2 to 7 days). The most common complication was temporary hypocalcemia, which occurred in 18% of patients.
Minimally invasive parathyroidectomy is an effective treatment of hyperparathyroidism caused by mediastinal parathyroid tissue. Targeted exploration depends on the guidance of preoperative localization studies and measurement of intraoperative parathyroid hormone levels to verify successful resection. Selective venous sampling and high-resolution computed tomography scanning can be helpful in patients with negative sestamibi scans.
颈部探查后仍患有难治性甲状旁腺功能亢进症的患者可能存在纵隔甲状旁腺，单凭单次影像学研究无法可靠识别。我们报告了 17 例经多点放射影像学证实后接受微创纵隔甲状旁腺瘤切除术的患者。
15 例患者行胸腔镜手术，2 例患者行纵隔镜手术切除疑似纵隔甲状旁腺瘤。术前定位研究包括锝 99m 甲氧基异丁基异腈扫描、颈部和胸部 CT 扫描以及甲状旁腺激素水平的选择性静脉取样。一旦确定纵隔位置，即行胸腔镜或纵隔镜切除。通过术中甲状旁腺激素水平降低 50%或更多来确认甲状旁腺组织的成功切除。
术后 88%的患者切除了甲状旁腺瘤。在有 2 项或更多的研究确定纵隔甲状旁腺组织定位的患者中，治愈率为 100%，在有 1 项阳性研究的患者中，治愈率为 60%。胸腔引流管于术后中位数第 1 天（范围 0 至 2 天）拔出。中位数住院时间为 3 天（范围 2 至 7 天）。最常见的并发症是暂时性低钙血症，发生在 18%的患者中。
微创甲状旁腺切除术是治疗纵隔甲状旁腺组织引起的甲状旁腺功能亢进症的有效方法。靶向探查取决于术前定位研究和术中甲状旁腺激素水平测量的指导，以验证成功切除。选择性静脉取样和高分辨率 CT 扫描对锝 99m 甲氧基异丁基异腈扫描阴性的患者可能有帮助。
