Kundel A, Thompson G B, Richards M L, Qiu L X, Cai Y, Schwenk F W, Lteif A N, Pittock S T, Kumar S, Tebben P J, Hay I D, Grant C S
Mayo Clinic, Rochester, Minnesota 55905.
J Clin Endocrinol Metab. 2014 Feb;99(2):399-406. doi: 10.1210/jc.2013-2617. Epub 2013 Dec 11.
Surgically managed endocrinopathies are rare in children. Most surgeons have limited experience in this field. Herein we report our operative experience with pediatric patients, performed over two decades by high-volume endocrine surgeons.
The study was conducted at the Mayo Clinic (a tertiary referral center).
Patients were <19 years old and underwent an endocrine operation (1993-2012).
Demographics, surgical procedure, diagnoses, morbidity, and mortality were retrospectively reviewed.
A total of 241 primary cases included 177 thyroid procedures, 13 neck dissections, 24 parathyroidectomies, 14 adrenalectomies, 7 paragangliomas, and 6 pancreatic procedures. Average age of patients was 14.2 years. There were 133 total thyroidectomies and 40 hemithyroidectomies. Fifty-three cases underwent a central or lateral neck dissection. Six-month follow-up was available for 98 total thyroidectomy patients. There were four cases of permanent hypoparathyroidism (4%) and no permanent recurrent laryngeal nerve (RLN) paralyses. Sequelae of neck dissections included temporary RLN neurapraxia and Horner's syndrome. Parathyroidectomy was performed on 24 patients: 20 with primary hyperparathyroidism (HPT), three with tertiary HPT, and one with familial hypocalciuric hypocalcemia. Three patients (16%) had recurrent HPT, all with multiglandular disease. One patient had temporary RLN neurapraxia. We performed seven bilateral and seven unilateral adrenalectomies; eight were laparoscopic. Indications included pheochromocytoma, Cushing's syndrome, adrenocortical carcinoma, congenital adrenal hyperplasia, and ganglioneuroma. One death was due to adrenocortical carcinoma. Five paraganglioma patients had succinate dehydrogenase subunit B mutations, and one recurred. Six patients with insulinoma underwent enucleation (n = 5) or distal pancreatectomy (n = 1). A single postoperative abscess was managed nonoperatively.
Pediatric endocrine procedures are uncommon but can be safely performed with complication rates comparable to those of the adult population. It is imperative that these operations be performed by high-volume surgeons.
手术治疗的儿童内分泌疾病较为罕见。大多数外科医生在该领域经验有限。在此，我们报告高年资内分泌外科医生在二十多年间对儿科患者的手术经验。
该研究在梅奥诊所（三级转诊中心）进行。
患者年龄小于19岁，接受了内分泌手术（1993 - 2012年）。
回顾性分析人口统计学资料、手术方式、诊断、发病率和死亡率。
总共241例原发性病例包括177例甲状腺手术、13例颈部清扫术、24例甲状旁腺切除术、14例肾上腺切除术、7例副神经节瘤手术和6例胰腺手术。患者平均年龄为14.2岁。共进行了133例全甲状腺切除术和40例半甲状腺切除术。53例患者接受了中央或侧方颈部清扫术。98例全甲状腺切除术患者获得了6个月的随访。有4例永久性甲状旁腺功能减退（4%），无永久性喉返神经麻痹。颈部清扫术的后遗症包括暂时性喉返神经失用和霍纳综合征。24例患者接受了甲状旁腺切除术：20例原发性甲状旁腺功能亢进（HPT），3例三发性HPT，1例家族性低钙性高钙血症。3例患者（16%）出现复发性HPT，均为多腺体疾病。1例患者出现暂时性喉返神经失用。我们进行了7例双侧和7例单侧肾上腺切除术；8例为腹腔镜手术。适应证包括嗜铬细胞瘤、库欣综合征、肾上腺皮质癌、先天性肾上腺皮质增生症和神经节瘤。1例死亡归因于肾上腺皮质癌。5例副神经节瘤患者有琥珀酸脱氢酶亚基B突变，1例复发。6例胰岛素瘤患者接受了摘除术（n = 5）或胰远端切除术（n = 1）。1例术后脓肿采用非手术治疗。
儿科内分泌手术并不常见，但可以安全进行，并发症发生率与成人相当。这些手术必须由高年资外科医生进行。
