Kunstman John W, Udelsman Robert
Yale University School of Medicine, New Haven, CT 06520, USA.
Adv Surg. 2012;46:171-89. doi: 10.1016/j.yasu.2012.04.004.
Because greater than 80% of spontaneous cases of primary hyperparathyroidism are caused by a single adenoma, BCE of the neck, which has long been the approach of choice, is being replaced. Focused parathyroidectomy has been made possible by advances in preoperative parathyroid localization and IOPTH monitoring, which allows confirmation of cure and confirmation of the absence of MGD without visualizing all 4 parathyroids. Several techniques for focused parathyroidectomy exist, but open MIP through an incision of 2 to 3 cm with surgeon-administered locoregional anesthesia seems to improve on the already high success rate and low morbidity associated withimproe on bilateral exploration. In addition, MIP is associated with numerous secondary benefits such as decreased hospital cost, improved patient satisfaction, decreased operative time, and same-day discharge. Bilateral exploration will remain the standard of care for most patients with multigland or syndromic disease. Most patients with sporadic PHPT are candidates for MIP.
由于超过80%的原发性甲状旁腺功能亢进自发病例是由单一腺瘤引起的，长期以来一直是首选手术方式的颈部双侧探查术正在被取代。术前甲状旁腺定位和术中甲状旁腺激素（IOPTH）监测技术的进步使聚焦甲状旁腺切除术成为可能，这使得在不显露全部4个甲状旁腺的情况下就能确认治愈情况以及有无多发性腺体疾病（MGD）。聚焦甲状旁腺切除术有多种技术，但通过2至3厘米切口并采用术者实施的局部区域麻醉进行开放式微创甲状旁腺切除术（MIP）似乎在已经很高的成功率以及与双侧探查相关的低发病率基础上更进一步。此外，MIP还有许多次要益处，如降低医院成本、提高患者满意度、缩短手术时间以及当日出院。双侧探查术仍将是大多数多腺体或综合征性疾病患者的治疗标准。大多数散发性原发性甲状旁腺功能亢进症（PHPT）患者适合进行MIP。
