Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin.
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin.
J Surg Res. 2014 Jul;190(1):198-202. doi: 10.1016/j.jss.2014.02.024. Epub 2014 Feb 22.
The incidence of recurrent primary hyperparathyroidism (PHPT) had been reported to be between 1% and 10%. The purpose of this study was to examine if patients with multigland disease have a different recurrence rate.
A retrospective analysis of a prospectively collected database was performed on patients with PHPT who underwent parathyroidectomy at one institution between 2001 and 2013. Patients who underwent initial parathyroidectomy with at least 6 mo of follow-up were included and were divided into three groups according to operative notes: single adenoma (SA), double adenoma (DA), and hyperplasia (HP). An elevated postoperative serum calcium level within 6 mo of surgery was defined as a persistent disease, whereas an elevated calcium after 6 mo was defined as a recurrence.
In total, 1402 patients met inclusion criteria, and the success rate of parathyroidectomy was 98.4%. The mean age was 60±14 y and 78.5% were female. Among them, 1097 patients (78%) had SA, 124 patients (9%) had DA, and 181 patients had HP (13%). The rate of persistent PHPT was higher among patients with DA (4%) versus SA (1.3%) and HP (2.2%) (P=0.0049). Moreover, the recurrence rate was higher among patients with DA (7.3%) versus SA (1.7%) and HP (4.4%) (P=0.0005) with identical median follow-up time. The median of the follow-up was 11 mo for patients with SA, 12.5 for patients with DA, and 12 for patients with HP (P=0.1603).
Recurrent and persistent PHPT occur more frequently in patients with DA. These data suggest that DA in some cases could represent asymmetric or asynchronous hyperplasia. Therefore, patients with DA may warrant more rigorous intraoperative scrutiny and more vigilant monitoring after parathyroidectomy.
复发性原发性甲状旁腺功能亢进症（PHPT）的发病率为 1%至 10%。本研究的目的是检查多腺体疾病患者的复发率是否不同。
对 2001 年至 2013 年期间在一家机构接受甲状旁腺切除术的 PHPT 患者进行前瞻性收集数据库的回顾性分析。纳入接受初始甲状旁腺切除术且随访至少 6 个月的患者，并根据手术记录分为三组：单发腺瘤（SA）、双发腺瘤（DA）和增生（HP）。术后 6 个月内血清钙水平升高定义为持续性疾病，而术后 6 个月后钙升高定义为复发。
共 1402 例患者符合纳入标准，甲状旁腺切除术的成功率为 98.4%。平均年龄为 60±14 岁，78.5%为女性。其中，1097 例（78%）为 SA，124 例（9%）为 DA，181 例为 HP（13%）。DA 患者（4%）的持续性 PHPT 发生率高于 SA（1.3%）和 HP（2.2%）（P=0.0049）。此外，DA 患者（7.3%）的复发率高于 SA（1.7%）和 HP（4.4%）（P=0.0005），且中位随访时间相同。SA 患者的中位随访时间为 11 个月，DA 患者为 12.5 个月，HP 患者为 12 个月（P=0.1603）。
DA 患者中复发性和持续性 PHPT 更为常见。这些数据表明，在某些情况下，DA 可能代表不对称或不同步的增生。因此，DA 患者可能需要在甲状旁腺切除术中进行更严格的检查，并在手术后进行更严密的监测。
