Endocrine Surgery Section, Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD 21287, USA.
World J Surg. 2012 Jan;36(1):55-60. doi: 10.1007/s00268-011-1344-8.
Minimally invasive parathyroidectomy (MIP) has become a well-accepted treatment for selected patients with primary hyperparathyroidism (PHPT). However, few studies have evaluated long-term outcomes for this operative approach. We therefore chose to examine both the long-term symptom resolution and biochemical cure following MIP for PHPT.
A total of 460 PHPT patients who underwent a MIP between 2004 and 2009 were successfully mailed a questionnaire that assessed preoperative and postoperative Parathyroidectomy Assessment of Symptoms (PAS) scores, most recent calcium and parathyroid hormone (PTH) levels, and information about any reoperation for PHPT. Long-term evaluation of symptomatic and biochemical cure was performed.
A total of 200 patients (43.5%) responded to our correspondence. The mean age of the patients was 58.7 ± 11.9 years, 74.5% were female, and 78.5% were Caucasian. The mean follow-up was 37 ± 19 months. The mean PAS scores fell by 117 ± 14 at long-term follow-up after MIP (P < 0.0001). All 13 symptoms comprising the PAS score diminished, of which ten did so significantly (P < 0.01). There was a significant drop in the mean serum calcium (preop. 11.1 mg/dl, postop. 9.6 mg/dl; P < 0.0001) and PTH (preop. 130.9 pg/ml, postop. 45.7 pg/ml; P < 0.0001) at long-term follow-up. Five patients (2.5%) developed recurrent disease (calcium > 10.5 mg/dl), and one (0.5%) underwent a reoperation for persistent disease and was subsequently cured.
This study demonstrates that MIP has long-term benefits in terms of excellent symptom resolution and a high biochemical cure rate (97%) in selected patients who have PHPT, preoperative localization with sestamibi scans, and assessment of intraoperative PTH level.
微创甲状旁腺切除术（MIP）已成为治疗原发性甲状旁腺功能亢进症（PHPT）的一种公认的治疗方法。然而，很少有研究评估这种手术方法的长期效果。因此，我们选择研究 MIP 治疗 PHPT 的长期症状缓解和生化治愈情况。
我们共对 2004 年至 2009 年间接受 MIP 的 460 例 PHPT 患者进行了成功的邮寄问卷调查，该问卷评估了术前和术后甲状旁腺切除术症状评估（PAS）评分、最近的钙和甲状旁腺激素（PTH）水平，以及 PHPT 再次手术的信息。对症状和生化治愈进行了长期评估。
共 200 例患者（43.5%）回复了我们的信函。患者的平均年龄为 58.7 ± 11.9 岁，74.5%为女性，78.5%为白种人。平均随访时间为 37 ± 19 个月。MIP 后长期随访时，PAS 评分平均降低 117 ± 14（P < 0.0001）。PAS 评分包含的 13 个症状均有所减轻，其中 10 个症状有显著减轻（P < 0.01）。血清钙（术前 11.1 mg/dl，术后 9.6 mg/dl；P < 0.0001）和 PTH（术前 130.9 pg/ml，术后 45.7 pg/ml；P < 0.0001）在长期随访中均显著下降。5 例患者（2.5%）出现疾病复发（血钙>10.5 mg/dl），1 例患者（0.5%）因持续性疾病接受了再次手术并随后治愈。
本研究表明，在选择的具有 PHPT、术前锝-99m sestamibi 扫描定位和术中 PTH 水平评估的患者中，MIP 具有长期益处，可实现出色的症状缓解和高生化治愈率（97%）。
