Fui Stéphanie Li Sun, Bonnichon Philippe, Bonni Nicolas, Delbot Thierry, André Jean Pascal, Pion-Graff Joëlle, Berrod Jean-Louis, Fontaine Marine, Brunaud Catherine, Cocagne Nicolas
IFCE, hôpital des Peupliers, 8, place de l'Abbé-G.-Hénocque, 75013 Paris, France.
IFCE, hôpital des Peupliers, 8, place de l'Abbé-G.-Hénocque, 75013 Paris, France.
Ann Endocrinol (Paris). 2016 Oct;77(5):600-605. doi: 10.1016/j.ando.2015.10.006. Epub 2016 Feb 23.
With the current aging of the world's population, diagnosis of primary hyperparathyroidism is being reported in increasingly older patients, with the associated functional symptomatology exacerbating the vicissitudes of age. This retrospective study was designed to establish functional improvements in older patients following parathyroid adenomectomy under local anesthesia as outpatient surgery.
Data were collected from 53 patients aged 80 years or older who underwent a minimally invasive parathyroid adenomectomy. All patients underwent a preoperative ultrasound, scintigraphy, and were monitored for the effectiveness of the procedure according to intra- and postdosage of parathyroid hormone (PTH) at 5min, 2h and 4h.
Mean preoperative serum calcium level was 2.8mmol/L (112mg/L) and mean PTH was 180pg/ml. Thirty-eight patients were operated under local anesthesia using minimally invasive surgery and 18 patients were operated under general anesthesia. In 26 cases, the procedure was planned on an outpatient basis but could only be carried out in 21 patients. Fifty-one patients had normal serum calcium and PTH levels during the immediate postoperative period. Two patients were reoperated under general anesthesia, since immediate postoperative PTH did not return to normal. Four patients died due to reasons unrelated to hyperparathyroidism. Five patients were lost to follow-up six months to two years postsurgery. Of the 44 patients (83%) with long-term monitoring for PTH, none had recurrence of biological hyperparathyroidism. Excluding the three asymptomatic patients, 38 of the 41 symptomatic patients (93%) with long-term follow-up were considering themselves as "improved" or "strongly improved" after the intervention, notably with respect to fatigue, muscle and bone pain. Two patients (4.9%) reported no difference and one patient (2.4%) said her condition had worsened and regretted having undergone surgery.
In patients 80 years or older, minimally invasive surgery as an outpatient under local anesthesia offered an excellent risk/benefit ratio given its many advantages: simplicity, speed, absence of general anesthesia, ease of monitoring, direct voice control intraoperatively, very low morbidity, effectiveness in treating primary hyperparathyroidism in more than 95% of first intention patients, and the possibility of immediate or delayed recovery in the event of multiglandular disease going unnoticed.
随着全球人口老龄化，原发性甲状旁腺功能亢进症在年龄越来越大的患者中被诊断出来，相关的功能症状加剧了年龄带来的变化。这项回顾性研究旨在确定老年患者在局部麻醉下作为门诊手术进行甲状旁腺腺瘤切除术后的功能改善情况。
收集了53例80岁及以上接受微创甲状旁腺腺瘤切除术患者的数据。所有患者均接受术前超声、闪烁扫描，并根据甲状旁腺激素（PTH）在5分钟、2小时和4小时的术中及术后剂量监测手术效果。
术前血清钙平均水平为2.8mmol/L（112mg/L），PTH平均水平为180pg/ml。38例患者在局部麻醉下采用微创手术，18例患者在全身麻醉下手术。26例患者计划门诊手术，但仅21例得以实施。51例患者术后即刻血清钙和PTH水平正常。2例患者因术后即刻PTH未恢复正常，在全身麻醉下再次手术。4例患者因与甲状旁腺功能亢进无关的原因死亡。5例患者在术后6个月至2年失访。在44例（83%）接受PTH长期监测的患者中，无生物性甲状旁腺功能亢进复发。排除3例无症状患者，41例有症状患者中38例（93%）长期随访后认为干预后“改善”或“明显改善”，尤其是在疲劳、肌肉和骨痛方面。2例患者（4.9%）表示无差异，1例患者（2.4%）称病情恶化并后悔接受手术。
对于80岁及以上患者，局部麻醉下门诊微创甲状旁腺手术具有诸多优势，风险/获益比极佳：操作简单、速度快、无需全身麻醉、易于监测、术中可直接语音控制、发病率极低、在超过95%的初治患者中有效治疗原发性甲状旁腺功能亢进症，以及在未发现多腺体疾病的情况下可实现即刻或延迟恢复。
