经颈胸腺切除术在甲状旁腺功能亢进症患者中的作用。

The role of transcervical thymectomy in patients with hyperparathyroidism.

机构信息

Northeast Ohio Medical University, Rootstown, OH, USA.

出版信息

Am J Surg. 2012 Mar;203(3):292-5; discussion 295-6. doi: 10.1016/j.amjsurg.2011.09.013. Epub 2012 Jan 4.

DOI:10.1016/j.amjsurg.2011.09.013

PMID:22221996

Abstract

BACKGROUND

The most common location for supernumerary or ectopic parathyroid glands is the thymus.

METHODS

A review of patients who underwent parathyroidectomy for hyperparathyroidism from 1990 to 2010 was completed to determine indications for thymectomy, the yield of parathyroid tissue, and outcome of therapy.

RESULTS

Seventy of 379 patients with hyperparathyroidism underwent parathyroidectomy and transcervical thymectomy. Intrathymic parathyroid tissue was present in 23 (33%) patients, including supernumerary glands in 8 patients (11%). Indications for thymectomy were renal hyperparathyroidism in 35 patients (50%) and primary hyperparathyroidism with a missing inferior gland in 20 patients (29%), an ectopic adenoma in 9 patients (13%), hyperplasia in 5 patients (7%), and carcinoma in 1 patient (1%). Cure rates were similar (96% and 98%; P = not significant) and only transient hypocalcemia was higher (51% vs 24%, P < .05) after parathyroidectomy with thymectomy versus parathyroidectomy alone.

CONCLUSIONS

Transcervical thymectomy results in a high yield of parathyroid tissue and is essential for cure of selected patients with hyperparathyroidism.

摘要

背景

甲状旁腺的异位或额外腺体最常见的位置是胸腺。

方法

对 1990 年至 2010 年期间因甲状旁腺功能亢进症而行甲状旁腺切除术的患者进行了回顾性分析，以确定行胸腺切除术的适应证、甲状旁腺组织的产量和治疗结果。

结果

379 例甲状旁腺功能亢进症患者中 70 例行甲状旁腺切除术和经颈胸腺切除术。23 例（33%）患者的胸腺内存在甲状旁腺组织，其中 8 例（11%）为额外腺体。行胸腺切除术的适应证为：35 例（50%）为肾性甲状旁腺功能亢进症和 20 例（29%）原发性甲状旁腺功能亢进症伴下腺缺如、9 例（13%）为异位腺瘤、5 例（7%）为增生和 1 例（1%）为癌。治愈率相似（96%和 98%；P=无显著差异），但胸腺切除术联合甲状旁腺切除术的暂时性低钙血症发生率更高（51%比 24%，P<0.05）。