Morris Lilah F, Lee Sukhyung, Warneke Carla L, Abadin Shabir S, Suliburk James W, Romero Arenas Minerva A, Lee Jeffrey E, Grubbs Elizabeth G, Perrier Nancy D
Section of Surgical Endocrinology, Department of Surgical Oncology, Houston, TX, USA.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Am J Surg. 2014 Nov;208(5):850-855. doi: 10.1016/j.amjsurg.2014.05.006. Epub 2014 Jul 11.
This study compared reoperative complication rates after initial minimally invasive parathyroidectomy and standard cervical exploration.
Records from patients who underwent 1 reoperative parathyroidectomy at a single institution (1998 to 2012) were retrospectively reviewed.
Seventy-seven patients were included; 74% underwent initial standard cervical exploration. Preoperative and operative characteristics were similar between groups; 74% underwent focused, unilateral reoperation. A significantly higher rate of postoperative complications occurred in the initial standard cervical exploration group (42% vs 15%, P = .03) that could not be explained by differences in the rates of symptomatic hypocalcemia (P = .5). The type of prior parathyroidectomy was significantly associated with postoperative complications (odds ratio 4.1, 95% confidence interval 1.1 to 15.7, P = .04). In a multivariable logistic regression model that included body mass index, type of operation (for initial and reoperation), and initial operation performed prereferral as covariates, type of prior parathyroidectomy remained a significant predictor of postoperative complications.
Higher rates of postoperative sequelae after initial standard cervical exploration should be considered before performing routine 4-gland exploration.
本研究比较了初次微创甲状旁腺切除术后再次手术的并发症发生率与标准颈部探查术后再次手术的并发症发生率。
回顾性分析了在单一机构接受1次再次甲状旁腺切除术的患者（1998年至2012年）的记录。
共纳入77例患者；74%的患者初次接受标准颈部探查。两组患者的术前和手术特征相似；74%的患者接受了针对性的单侧再次手术。初次标准颈部探查组术后并发症发生率显著更高（42%对15%，P = .03），这不能用症状性低钙血症发生率的差异来解释（P = .5）。既往甲状旁腺切除术的类型与术后并发症显著相关（比值比4.1，95%置信区间1.1至15.7，P = .04）。在一个多变量逻辑回归模型中，将体重指数、手术类型（初次和再次手术）以及转诊前进行的初次手术作为协变量纳入分析，既往甲状旁腺切除术的类型仍然是术后并发症的显著预测因素。
在进行常规的四腺探查之前，应考虑初次标准颈部探查术后较高的术后后遗症发生率。
