García-Santos Esther Pilar, Martín-Fernández Jesús, Gil-Rendo Aurora, Menchén-Trujillo Bruno, Martínez de Paz Fernando, Manzanares-Campillo M Carmen, Muñoz-Atienza Virginia, Sánchez-García Susana
Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
Endocrinol Nutr. 2014 Jan;61(1):3-8. doi: 10.1016/j.endonu.2013.03.013. Epub 2013 Jul 30.
Primary hyperparathyroidism (PHPT) is due to a single adenoma in 85%-95% of cases, and is often cured after adenoma removal. Intraoperative rapid determination of intact parathyroid hormone (PTHio) may be a tool for monitoring the effectiveness of PHPT surgery. The main objective of our study was to evaluate PTHio determination and to establish whether its successful implementation contributed to achieve minimally invasive surgery (MIS) and major ambulatory surgery (MAS) in the treatment of PHPT.
Retrospective study of a consecutive series of patients diagnosed and operated on for PHPT at the University General Hospital of Ciudad Real between January 2005 and January 2012.
In the study period, 91 patients underwent surgery. 39 (42.9%) under general anesthesia, while 52 (57.1%) were candidates for regional anesthesia by cervical block. Seventy-six of all patients (83.5%) were amenable to MIS using a unilateral approach. Classical cervicotomy was performed in all other patients. PTHio determination was done in 75 patients, showing cure in the same surgery in 68 of them. MAS was performed in 70.3% (64) of patients.
Determination of PTHio may allow for changing the surgical approach to PHPT at our department, allowing for performance of MIS on an outpatient basis in a significant proportion of patients with some cosmetic improvement, probably less pain, shorter hospital stay, and less potential complications than bilateral cervical exploration.
在85%-95%的病例中，原发性甲状旁腺功能亢进症（PHPT）是由单个腺瘤引起的，腺瘤切除后通常可治愈。术中快速测定完整甲状旁腺激素（PTHio）可能是监测PHPT手术效果的一种手段。我们研究的主要目的是评估PTHio测定，并确定其成功实施是否有助于在PHPT治疗中实现微创手术（MIS）和主要门诊手术（MAS）。
对2005年1月至2012年1月在雷阿尔城大学综合医院连续诊断并接受PHPT手术的一系列患者进行回顾性研究。
在研究期间，91例患者接受了手术。39例（42.9%）接受全身麻醉，而52例（57.1%）适合通过颈丛阻滞进行区域麻醉。所有患者中有76例（83.5%）适合采用单侧入路进行MIS。所有其他患者均进行了经典的颈部切开术。75例患者进行了PTHio测定，其中68例在同一次手术中治愈。70.3%（64例）的患者进行了MAS。
PTHio测定可能使我们科室改变PHPT的手术方式，使相当一部分患者能够在门诊进行MIS，与双侧颈部探查相比，可能具有一些美容改善、疼痛减轻、住院时间缩短和潜在并发症减少的优点。
