Norlén Olov, Wang Kuan Chi, Tay Yeng Kwang, Johnson William R, Grodski Simon, Yeung Meei, Serpell Jonathan, Sidhu Stan, Sywak Mark, Delbridge Leigh
*University of Sydney Endocrine Surgical Unit, Sydney, New South Wales, Australia; and †Monash University Endocrine Surgery Unit, Melbourne, Victoria, Australia.
Ann Surg. 2015 May;261(5):991-6. doi: 10.1097/SLA.0000000000000715.
The aim of this study was to investigate long-term outcomes after focused parathyroidectomy (FPTX) and open 4-gland parathyroid exploration (OPTX) for primary hyperparathyroidism (pHPT).
Concerns about increased long-term recurrence rates after FPTX in conjunction with decreased operative times for OPTX have led some groups to abandon FPTX in favor of routine 4-gland exploration.
This is a multicenter retrospective cohort study of patients undergoing parathyroidectomy for pHPT from 1990 to 2013. The patient cohort was divided into 2 groups, FPTX and OPTX, based on intention-to-treat analysis. The primary outcome measure was the persistence of pHPT. Secondary outcome measures were differences in the long-term recurrence rate of persisting pHPT and surgical complications.
A total of 4569 patients (3585 females) were included. The overall persistence and recurrence rates were 2.2% and 0.9%, respectively, after a median follow-up of 6.5 years. There were 2531 FPTX cases and 2038 OPTX cases. The initial persistence rate was higher for FPTX than for OPTX (2.7% vs 1.7%, P = 0.036); however, the long-term recurrence rate was not different (5-year 0.6% vs 0.4%, log-rank P = 0.08). Complications were more common in OPTX than in FPTX (7.6% vs 3.6%, P < 0.001).
FPTX was associated with fewer operative complications and an equivalent rate of long-term recurrence than with OPTX. Although initial persistence rates were higher after FPTX than after OPTX, most were readily resolved with subsequent early reoperation. FPTX should not be abandoned in patients with positive preoperative localization.
本研究旨在调查原发性甲状旁腺功能亢进症（pHPT）患者接受聚焦甲状旁腺切除术（FPTX）和开放性四腺甲状旁腺探查术（OPTX）后的长期结局。
对FPTX术后长期复发率增加以及OPTX手术时间缩短的担忧，导致一些团队放弃FPTX而倾向于常规的四腺探查术。
这是一项多中心回顾性队列研究，研究对象为1990年至2013年因pHPT接受甲状旁腺切除术的患者。根据意向性分析，将患者队列分为FPTX和OPTX两组。主要结局指标为pHPT的持续存在情况。次要结局指标为持续存在的pHPT的长期复发率和手术并发症的差异。
共纳入4569例患者（3585例女性）。中位随访6.5年后，总体持续存在率和复发率分别为2.2%和0.9%。有2531例FPTX病例和2038例OPTX病例。FPTX的初始持续存在率高于OPTX（2.7%对1.7%，P = 0.036）；然而，长期复发率并无差异（5年时为0.6%对0.4%，对数秩检验P = 0.08）。OPTX的并发症比FPTX更常见（7.6%对3.6%，P < 0.001）。
与OPTX相比，FPTX的手术并发症更少，长期复发率相当。虽然FPTX后的初始持续存在率高于OPTX，但大多数通过随后的早期再次手术可轻松解决。对于术前定位阳性的患者，不应放弃FPTX。
