Rothmund M, Wagner P K, Seesko H, Zielke A
Klinik für Allgemeinchirurgie, Universität Marburg.
Dtsch Med Wochenschr. 1990 Oct 19;115(42):1579-85. doi: 10.1055/s-2008-1065194.
On the basis of 70 re-operations in 55 patients (34 women, 21 men, median age 58 [43-83] years) suffering from primary hyperparathyroidism the reasons for failure of the first operations were analysed. The main reasons were inadequate exploration of the neck (failure to identify all four glands), failure to recognize multiple gland involvement, or inadequate resection in cases where more than one gland was affected. An abnormally situated gland was a less common cause, as shown by the fact that 41 out of the 73 glands removed at the last re-operation were situated in the normal position or in its immediate vicinity; in 20 cases the surgeon had failed to recognise multiple gland disease. Next in order of importance were anatomical variations in the location (32 out of 73 tumours) or the number of the glands (9 patients with hyperplasia of 5 glands). At the re-operations 89% of the parathyroid tumours were found in the neck region or would have been accessible from the neck at the time of the first operation. Overall, the hypercalcaemia was permanently rectified in 96.6% of the patients. During the last 10 years 94% of patients have been normocalcaemic postoperatively, thanks mainly to the re-implantation of autologous parathyroid tissue, preserved by low-temperature storage. The incidence of permanent unilateral recurrent nerve paresis attributable to the re-operations was 6%.
基于对55例原发性甲状旁腺功能亢进患者（34例女性，21例男性，中位年龄58[43 - 83]岁）进行的70次再次手术，分析了首次手术失败的原因。主要原因包括颈部探查不充分（未识别出全部四个腺体）、未认识到多腺体受累，或在一个以上腺体受累的情况下切除不充分。腺体位置异常是较不常见的原因，这体现在最后一次再次手术切除的73个腺体中有41个位于正常位置或其紧邻区域；在20例中外科医生未认识到多腺体疾病。其次重要的是腺体位置（73个肿瘤中有32个）或数量（9例5个腺体增生的患者）的解剖变异。在再次手术中，89%的甲状旁腺肿瘤在颈部区域被发现，或在首次手术时可从颈部触及。总体而言，96.6%的患者高钙血症得到永久性纠正。在过去10年中，94%的患者术后血钙正常，这主要归功于通过低温保存的自体甲状旁腺组织的再植入。再次手术导致的永久性单侧喉返神经麻痹发生率为6%。
