微创视频辅助甲状旁腺切除术与传统甲状旁腺切除术治疗甲状旁腺腺瘤的比较。
A comparison of minimally invasive video-assisted parathyroidectomy and traditional parathyroidectomy for parathyroid adenoma.
机构信息
1. Department of Surgery -University Hospital of Parma;
出版信息
J Cancer. 2013 Jul 3;4(6):458-63. doi: 10.7150/jca.6755. Print 2013.
BACKGROUND
Pre-operative imaging techniques for sporadic primary hyperparathyroidism (SPHPT) and intraoperative parathyroid hormone (ioPTH) have led to the wide spread use of minimally invasive surgical approaches.
STUDY DESIGN
In our prospectively collected database, 157 subjects with SPHPT and a preoperative diagnosis of parathyroid adenoma were treated with parathyroidectomy between January 2003 and November 2011. Subjects in group A were enrolled between January 2003 to September 2006, and underwent traditional parathyroidectomy with intraoperative frozen section and bilateral neck exploration. Subjects in group B were enrolled between September 2006 to November 2011, and underwent minimally invasive video-assisted parathyroidectomy (MIVAP) with ioPTH. Operative times and post-operative pain levels were compared between groups. Subjects were followed for a minimum of 6 months post-operatively and recurrence rates and complication rates were measured between groups.
RESULTS
81 subjects were enrolled in group A, and 76 subjects were enrolled in group B. Pre-operative evaluation demonstrated that the groups were statistically similar. Significantly decreased operative times (28min vs. 62min) and post-operative pain levels were noted in group B. Recurrence rates were similar between group A (3.7%) and group B (2.6%).
CONCLUSIONS
MIVAP with ioPTH demonstrated significantly improved operative times and post-operative pain levels, while maintaining equivalent recurrence rates.
背景
散发性甲状旁腺功能亢进症（SPHPT）的术前影像技术和术中甲状旁腺激素（ioPTH）的应用，导致微创外科方法的广泛应用。
研究设计
在我们前瞻性收集的数据库中，有 157 例 SPHPT 患者，术前诊断为甲状旁腺瘤，在 2003 年 1 月至 2011 年 11 月期间接受甲状旁腺切除术治疗。A 组患者于 2003 年 1 月至 2006 年 9 月期间入组，接受术中冰冻切片和双侧颈部探查的传统甲状旁腺切除术。B 组患者于 2006 年 9 月至 2011 年 11 月期间入组，接受微创视频辅助甲状旁腺切除术（MIVAP）和 ioPTH。比较两组的手术时间和术后疼痛程度。所有患者术后随访至少 6 个月，比较两组的复发率和并发症发生率。
结果
A 组 81 例患者，B 组 76 例患者。术前评估表明两组在统计学上相似。B 组的手术时间（28 分钟 vs. 62 分钟）和术后疼痛程度显著降低。A 组（3.7%）和 B 组（2.6%）的复发率相似。
结论
MIVAP 联合 ioPTH 显著缩短手术时间和减轻术后疼痛，同时保持相似的复发率。
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