Lee Sukhyung, Ryu Haengrang, Morris Lilah F, Grubbs Elizabeth G, Lee Jeffrey E, Harun Nusrat, Feng Lei, Perrier Nancy D
Section of Surgical Endocrinology, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,
Ann Surg Oncol. 2014 Jun;21(6):1878-83. doi: 10.1245/s10434-013-3479-3. Epub 2014 Jan 23.
Minimally invasive parathyroidectomy (MIP) is a targeted operation to cure primary hyperparathyroidism utilizing intraoperative parathyroid hormone monitoring (IOPTH). The purpose of this study was to quantify the operative failure of MIP.
Utilizing institutional parathyroid surgery database, demographic, operative, and biochemical data were analyzed for successful and failed MIP. Operative failure was defined as <6 months of eucalcemia after operation.
Five hundred thirty-eight patients (96.6 %) had successful MIP with mean follow-up of 13 months, and 19 (3.4 %) had operative failure. The major cause of operative failure (11 of 19) was the result of surgeons' inability to identify all abnormal parathyroid glands. The remaining eight operative failures were the result of falsely positive IOPTH results. Eleven of 19 patients whose MIP had failed underwent a second parathyroid surgery. All but one of these patients achieved operative success, and 9 patients had missed multigland disease. Only 46 (8.3 %) of 557 patients had conversion to bilateral cervical exploration (BCE). Eighty percent of patients had more than 70 % IOPTH decrease, and all had successful operations. Patients with a marginal IOPTH decrease (50-59 %) had a treatment failure rate of 20 %.
The most common cause of operative failure in MIP utilizing IOPTH was the result of surgeons' failure to identify all abnormal parathyroid glands. Falsely positive IOPTH is rare, and a targeted MIP utilizing IOPTH can achieve an excellent operative success rate without routine BCE. Selective BCE on patients with marginal IOPTH decrease may improve surgical outcome.
微创甲状旁腺切除术（MIP）是一种利用术中甲状旁腺激素监测（IOPTH）来治疗原发性甲状旁腺功能亢进的靶向手术。本研究的目的是量化MIP的手术失败率。
利用机构甲状旁腺手术数据库，对成功和失败的MIP的人口统计学、手术和生化数据进行分析。手术失败定义为术后血钙正常持续时间小于6个月。
538例患者（96.6%）MIP手术成功，平均随访13个月，19例（3.4%）手术失败。手术失败的主要原因（19例中的11例）是外科医生无法识别所有异常甲状旁腺。其余8例手术失败是IOPTH结果假阳性所致。19例MIP手术失败的患者中有11例接受了二次甲状旁腺手术。除1例患者外，所有这些患者手术均成功，9例患者存在多腺体疾病漏诊。557例患者中只有46例（8.3%）转为双侧颈部探查（BCE）。80%的患者IOPTH下降超过70%，且所有患者手术均成功。IOPTH下降幅度较小（50 - 59%）的患者治疗失败率为20%。
在使用IOPTH的MIP中，手术失败最常见的原因是外科医生未能识别所有异常甲状旁腺。IOPTH假阳性很少见，使用IOPTH的靶向MIP无需常规BCE即可获得出色的手术成功率。对IOPTH下降幅度较小的患者进行选择性BCE可能会改善手术效果。
