Madsen Anders Rørbæk, Rasmussen Lars, Godballe Christian
Department of ENT Head and Neck Surgery (F), Odense University Hospital, Sdr. Boulevard, 5000, Odense, Denmark.
Department of Surgery, Odense University Hospital, Odense, Denmark.
Eur Arch Otorhinolaryngol. 2016 Jun;273(6):1599-605. doi: 10.1007/s00405-015-3678-6. Epub 2015 Jun 5.
Surgery for primary hyperparathyroidism (pHPT) has a high cure-rate and few complications. Preoperative localization procedures have permitted a dramatic shift from routine bilateral exploration to focused, minimally invasive procedures. At Odense University Hospital, Denmark, the introduction of focused surgery was combined with training of new surgeons. The objective of this study was to identify possible risk factors for treatment failure with special focus on surgical strategy and training of new surgeons. A 6-year prospective and consecutive series of 567 pHPT patients operated at Odense University hospital, Denmark, was analyzed. A shift in strategy was made in 2006 and at the same time new surgeons started training in parathyroid surgery. Biochemical-, clinical- and follow-up data were analyzed. Overall cure-rate was 90.7 %. Complication rates were 1.1 % for hemorrhage, 1.1 % for wound infection and 0.9 % for recurrent nerve paralysis. The only significant predictor of treatment failure at 6 months was histology of hyperplasia (OR 4.3). Neither the introduction of minimal invasive surgical strategy nor the training of new surgeons had a significant influence on the rate of treatment failures. Hyperplasia is a significant predictor of treatment failure in pHPT surgery. A shift towards systematic preoperative localization with focused surgery as well as training of new surgeons can be done without negative impact on treatment results. Identification of the hyperplasia and multigland patients in need of bilateral cervical exploration is crucial to avoid failures and raise cure rates.
原发性甲状旁腺功能亢进症（pHPT）的手术治愈率高且并发症少。术前定位程序已使手术方式从常规双侧探查大幅转向精准、微创的手术方式。在丹麦欧登塞大学医院，精准手术的引入与新外科医生的培训相结合。本研究的目的是确定治疗失败的可能风险因素，特别关注手术策略和新外科医生的培训。对丹麦欧登塞大学医院连续6年进行手术的567例pHPT患者进行了前瞻性分析。2006年手术策略发生了转变，同时新外科医生开始接受甲状旁腺手术培训。对生化、临床和随访数据进行了分析。总体治愈率为90.7%。出血并发症发生率为1.1%，伤口感染并发症发生率为1.1%，喉返神经麻痹并发症发生率为0.9%。6个月时治疗失败的唯一显著预测因素是增生的组织学情况（比值比4.3）。微创外科手术策略的引入和新外科医生的培训对治疗失败率均无显著影响。增生是pHPT手术治疗失败的一个重要预测因素。向以精准手术为基础的系统术前定位以及新外科医生培训的转变不会对治疗结果产生负面影响。识别需要进行双侧颈部探查的增生和多腺体患者对于避免手术失败和提高治愈率至关重要。
