Wei Bo-jun, Shen Hong, Xing Xiao-ping, Ji Wei, Zhao Liang, Wang Jia, Xie Hong, Zhou Xiao-hong, Yin Jin-shu, Jiang Tao, Chang Hong, Shi Feng
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Shijitan Hospital, Beijing 100038, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2011 Nov;46(11):901-4.
To evaluate the factors contributed to the recurrence of parathyroid carcinoma with the invasion of the upper aerodigestive tract and the outcomes of reoperation.
Six cases reviewed, in which the age ranged from 32 to 79 years old. The initial diagnoses and surgical procedures, the sites and surgical treatment of the recurrent disease, and the chemical markers, such as parathyroid hormone (PTH) and serum calcium, were retrospectively studied. The preoperative PTH levels ranged from 860 to 2830 ng/L. In 4 patients the recurrence diseases were founded in the tracheoesophageal groove, of them one with invasion of the larynx only and one with invasion of the larynx and pharynx in addition to the trachea and esophagus involvement. Selective neck dissection for level II, III, IV and VI was taken in all cases in addition to the removal of the local recurrent diseases. Recurrent laryngeal nerves were so badly embedded in tumor tissue that they were intentionally resected in 4 patients although they were functionally normal before operation. Prophylactic tracheostomy was carried out in 5 cases.
PTH level dropped more than 70% of that prior the operation at 10 min after the removal of the tumor-bearing tissues and to normal range within the first 2 hours postoperatively, and hypocalcemia disappeared in 2 days postoperatively. All cases experienced significant improvement in symptoms and signs in the first three days postoperatively. PTH and serum calcium levels were within normal range in 4 cases during the follow-up of 11 to 40 months, while hyperparathyroidism was encountered 8 and 11 months postoperatively in other 2 cases, respectively. Esophageal fistula, chylous fistula and dehiscence of sternotomy developed in 3 cases separately. Of 5 patients with tracheostomy, the tracheostomy tubes were removed two weeks in 4 cases and six weeks in the other one after operation.
Recurrent parathyroid carcinoma even with invasion of the upper aerodigestive tract still has promising surgical outcomes. Both the precise localization of the recurrent diseases and the intraoperative PTH assay are importance to the successful treatment of these diseases.
评估导致甲状旁腺癌复发并侵犯上呼吸道消化道的相关因素以及再次手术的结果。
回顾6例患者，年龄范围为32至79岁。对初始诊断和手术方式、复发病灶的部位及手术治疗情况，以及甲状旁腺激素（PTH）和血清钙等化学标志物进行回顾性研究。术前PTH水平为860至2830 ng/L。4例患者的复发病灶位于气管食管沟，其中1例仅侵犯喉部，1例除气管食管受累外还侵犯喉和咽。除切除局部复发病灶外，所有病例均行Ⅱ、Ⅲ、Ⅳ和Ⅵ区选择性颈清扫术。4例患者的喉返神经虽术前功能正常，但因被肿瘤组织严重包绕而被有意切除。5例行预防性气管切开术。
切除肿瘤组织后10分钟，PTH水平降至术前的70%以上，并在术后2小时内恢复至正常范围，术后2天低钙血症消失。所有病例术后前三天症状和体征均有明显改善。随访11至40个月期间有4例患者的PTH和血清钙水平在正常范围内，另外2例患者分别在术后8个月和11个月出现甲状旁腺功能亢进。3例患者分别出现食管瘘、乳糜瘘和胸骨切开处裂开。5例气管切开患者中，4例术后2周拔除气管套管，另1例术后6周拔除。
即使侵犯上呼吸道消化道的复发性甲状旁腺癌手术仍有良好疗效。复发病灶的精确定位及术中PTH测定对这些疾病的成功治疗均很重要。
