Singh Ospina Naykky M, Rodriguez-Gutierrez Rene, Maraka Spyridoula, Espinosa de Ycaza Ana E, Jasim Sina, Castaneda-Guarderas Ana, Gionfriddo Michael R, Al Nofal Alaa, Brito Juan P, Erwin Patricia, Richards Melanie, Wermers Robert, Montori Victor M
Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA.
World J Surg. 2016 Oct;40(10):2359-77. doi: 10.1007/s00268-016-3514-1.
Parathyroidectomy is a definitive treatment for primary hyperparathyroidism. Patients contemplating this intervention will benefit from knowledge regarding the expected outcomes and potential risks of the currently available surgical options.
To appraise and summarize the available evidence regarding benefits and harms of minimally invasive parathyroidectomy (MIP) and bilateral neck exploration (BNE).
A comprehensive search of multiple databases (MEDLINE, EMBASE, and Scopus) from each database's inception to September 2014 was performed.
Eligible studies evaluated patients with primary hyperparathyroidism undergoing MIP or BNE.
Reviewers working independently and in duplicate extracted data and assessed the risk of bias.
We identified 82 observational studies and 6 randomized trials at moderate risk of bias. Most of them reported outcomes after MIP (n = 71). Using random-effects models to pool results across studies, the cure rate was 98 % (95 % CI 97-98 %, I (2) = 10 %) with BNE and 97 % (95 % CI 96-98 %, I (2) = 86 %) with MIP. Hypocalcemia occurred in 14 % (95 % CI 10-17 % I (2) = 93 %) of the BNE cases and in 2.3 % (95 % CI 1.6-3.1 %, I (2) = 87 %) with MIP (P < 0.001). There was a statistically significant lower risk of laryngeal nerve injury with MIP (0.3 %) than with BNE (0.9 %), but similar risk of infection (0.5 vs. 0.5 %) and mortality (0.1 vs. 0.5 %).
The available evidence, mostly observational, is at moderate risk of bias, and limited by indirect comparisons and inconsistency for some outcomes (cure rate, hypocalcemia).
MIP and BNE are both effective surgical techniques for the treatment of primary hyperparathyroidism. The safety profile of MIP appears superior to BNE (lower rate of hypocalcemia and recurrent laryngeal nerve injury).
甲状旁腺切除术是原发性甲状旁腺功能亢进的确定性治疗方法。考虑进行这种干预的患者将受益于有关当前可用手术选择的预期结果和潜在风险的知识。
评估和总结关于微创甲状旁腺切除术（MIP）和双侧颈部探查术（BNE）的益处和危害的现有证据。
对多个数据库（MEDLINE、EMBASE和Scopus）从每个数据库创建到2014年9月进行了全面搜索。
符合条件的研究评估了接受MIP或BNE的原发性甲状旁腺功能亢进患者。
独立且重复工作的评审人员提取数据并评估偏倚风险。
我们识别出82项观察性研究和6项偏倚风险为中度的随机试验。其中大多数报告了MIP后的结果（n = 71）。使用随机效应模型汇总各研究结果，BNE的治愈率为98%（95%CI 97 - 98%，I² = 10%），MIP的治愈率为97%（95%CI 96 - 98%，I² = 86%）。BNE病例中有14%（95%CI 10 - 17%，I² = 93%）发生低钙血症，MIP病例中有2.3%（95%CI 1.6 - 3.1%，I² = 87%）发生低钙血症（P < 0.001）。MIP导致喉返神经损伤的风险（0.3%）在统计学上显著低于BNE（0.9%），但感染风险（0.5%对0.5%）和死亡率（0.1%对0.5%）相似。
现有证据大多为观察性的，存在中度偏倚风险，并且受某些结果（治愈率、低钙血症）的间接比较和不一致性的限制。
MIP和BNE都是治疗原发性甲状旁腺功能亢进的有效手术技术。MIP的安全性似乎优于BNE（低钙血症和喉返神经损伤发生率较低）。
