Proye C, Quievreux J L, Gontier A, Carnaille B, Vincent P, Bizard J P
Chirurgie. 1989;115(10):723-32.
Multiple gland enlargement (M.G.E.) in primary hyperparathyroidism (H.P.T.) is the presence of 2 or more enlarged glands weighing more than 50 mg. Conservative surgery (C.S.) consists of resecting the grossly enlarged glands without biopsying the normal glands. Some authors have suggested that C.S. might overlook minute hyperplasia, hence leading to late recurrences of H.P.T., or conversely result in the unnecessary resection of grossly enlarged, but not hyperfunctioning glands. 379 patients have been operated upon for H.P.T. 86 (22.7%) had M.G.E. including 13 (15.2%) M.E.N. cases, 8 (9.3%) familial cases and 65 (75.6%) seemingly sporadic cases (S.S.C.). 2, 3 or 4 glands (or more) were involved in 39.5%, 35% and 25.5% of cases respectively. 1 patient died post-operatively and 3--all S.S.C. with hyperplasia--had to be reoperated upon within 1 year for persistent hypercalcemia. Pathological diagnosis was: double adenomas in 5.8%, hyperplasia in 36%, adenoma associated with hyperplasia in 46.5% and a normal second gland, on light microscopy findings in 11.7%. None of 13 deaths occurring during follow-up was related to H.P.T. 78 patients (90.7%) are available for follow-up (av. 85.3 months). 85.9% are normocalcemic (2.2 less than Ca less than 2.6 mmol/l), 5.1% hypocalcemic and 9% hypercalcemic. 61 had late i. P.T.H. assay; i. P.T.H. was appropriate to serum calcium in 78.7% and appropriate to normal serum calcium levels in 90.6% of 53 normocalcemic cases.
原发性甲状旁腺功能亢进症（H.P.T.）中的多腺体增大（M.G.E.）是指存在两个或更多个重量超过50毫克的增大腺体。保守手术（C.S.）包括切除明显增大的腺体，而不对正常腺体进行活检。一些作者认为，保守手术可能会忽略微小的增生，从而导致甲状旁腺功能亢进症的晚期复发，或者相反，导致对明显增大但无功能亢进的腺体进行不必要的切除。379例患者因甲状旁腺功能亢进症接受了手术。86例（22.7%）有多腺体增大，其中包括13例（15.2%）多内分泌腺瘤病（M.E.N.）病例、8例（9.3%）家族性病例和65例（75.6%）看似散发性病例（S.S.C.）。分别有39.5%、35%和25.5%的病例累及2个、3个或4个腺体（或更多）。1例患者术后死亡，3例——均为伴有增生的散发性病例——因持续性高钙血症在1年内不得不再次手术。病理诊断为：光镜检查结果显示，双腺瘤占5.8%，增生占36%，腺瘤合并增生占46.5%，第二个腺体正常占11.7%。随访期间发生的13例死亡均与甲状旁腺功能亢进症无关。78例患者（90.7%）可供随访（平均85.3个月）。85.9%的患者血钙正常（2.2＜血钙＜2.6毫摩尔/升），5.1%的患者血钙过低，9%的患者血钙过高。61例患者进行了晚期甲状旁腺激素（i.P.T.H.）检测；在53例血钙正常的病例中，78.7%的患者甲状旁腺激素与血钙水平相符，90.6%的患者甲状旁腺激素与正常血钙水平相符。
