Lee James C, Mazeh Haggi, Serpell Jonathan, Delbridge Leigh W, Chen Herbert, Sidhu Stanley
Endocrine Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Department of Surgery, The University of Sydney, Sydney, New South Wales, Australia.
ANZ J Surg. 2015 Dec;85(12):957-61. doi: 10.1111/ans.12017. Epub 2012 Dec 10.
Missed parathyroid adenoma (PTA) is the commonest cause of persistent hyperparathyroidism. Although many are subsequently found in well-described locations, some are found in unusual regions of the neck. This paper presents the combined experience of three large tertiary endocrine surgery centres with maldescended PTA (MD-PTA).
Patients were recruited from the endocrine surgical databases of three tertiary endocrine surgery units. Patients with PTA found >1 cm above the superior thyroid pole or other cervical locations as a result of abnormal or incomplete descent were included for analysis.
MD-PTA was identified in 16 patients out of a total of 5241 patients who had undergone parathyroidectomies in the 7-year study period (incidence 0.3%). Seven (44%) patients had minimally invasive parathyroidectomy, while nine (56%) had bilateral neck exploration. The mean excised gland weight was 750 + 170 mg. Cure was achieved in all patients with a minimum follow-up of 6 months. The locations of MD-PTA in this study included submandibular triangle, retropharyngeal space, carotid sheath (at carotid bifurcation and intravagal), parapharyngeal space (superior to thyroid cartilage or superior thyroid pole) and cricothyroid space.
Despite their rare occurrence, incompletely or abnormally descended PTAs can be encountered by any surgeon who performs parathyroidectomies. It is important to develop a strategy to systematically locate these glands. High cure rates can still be achieved with minimally invasive parathyroidectomy if confident preoperative localization is available. A sound knowledge of embryology and a thorough exploration also facilitate an overall high success rate with open exploration.
甲状旁腺腺瘤（PTA）遗漏是持续性甲状旁腺功能亢进最常见的原因。尽管许多遗漏的甲状旁腺腺瘤随后在描述清晰的位置被发现，但有些位于颈部的不寻常区域。本文介绍了三个大型三级内分泌外科中心处理下降异常的甲状旁腺腺瘤（MD-PTA）的综合经验。
从三个三级内分泌外科单位的内分泌外科数据库中招募患者。因甲状旁腺下降异常或不完全而在甲状腺上极上方>1 cm或其他颈部位置发现甲状旁腺腺瘤的患者纳入分析。
在7年研究期间接受甲状旁腺切除术的5241例患者中，有16例被确定为MD-PTA（发病率0.3%）。7例（44%）患者接受了微创甲状旁腺切除术，9例（56%）患者接受了双侧颈部探查。切除腺体的平均重量为750 + 170 mg。所有患者均获治愈，最短随访6个月。本研究中MD-PTA的位置包括下颌下三角、咽后间隙、颈动脉鞘（在颈动脉分叉处和迷走神经内）、咽旁间隙（甲状腺软骨上方或甲状腺上极上方）和环甲间隙。
尽管下降异常的甲状旁腺腺瘤很少见，但任何进行甲状旁腺切除术的外科医生都可能遇到甲状旁腺下降不完全或异常的情况。制定系统定位这些腺体的策略很重要。如果术前能进行可靠的定位，微创甲状旁腺切除术仍可获得高治愈率。对胚胎学的充分了解和彻底的探查也有助于开放探查获得总体高成功率。
