Katz A D, Formichella D
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048.
Am J Surg. 1989 Oct;158(4):385-7. doi: 10.1016/0002-9610(89)90140-2.
Fifty-three patients, 35 with persistent and 7 with recurrent hyperparathyroidism, had parathyroid surgery. There were 11 patients who had prior thyroid surgery before being identified as having hyperparathyroidism. Forty patients had parathyroid adenomas and 13 (8 dialysis patients) had parathyroid hyperplasia. Thallium-210-iodine 123 subtraction scanning proved to be the most accurate in localizing parathyroid adenomas (60 percent) but not parathyroid hyperplasia. Resection of 3 3/4 parathyroid glands in primary parathyroid hyperplasia and total parathyroidectomy with parathyroid autotransplantation in tertiary parathyroid hyperplasia are the treatments of choice and would have prevented reoperation in this group. Careful neck exploration, resection of the thymus, and even thyroidectomy would probably have led to the correct location of the missed parathyroid adenomas. Mediastinotomy should not be performed at initial surgery. A careful history and preoperative calcium and phosphorus determinations in all thyroid surgery patients will reveal occult hyperparathyroidism. Twenty-one such patients were identified in our overall parathyroid series.
53例甲状旁腺功能亢进患者接受了甲状旁腺手术，其中35例为持续性甲状旁腺功能亢进，7例为复发性甲状旁腺功能亢进。有11例患者在被确诊为甲状旁腺功能亢进之前曾接受过甲状腺手术。40例患者患有甲状旁腺腺瘤，13例（8例为透析患者）患有甲状旁腺增生。铊-210-碘-123减影扫描在定位甲状旁腺腺瘤方面最为准确（60%），但对甲状旁腺增生则不准确。原发性甲状旁腺增生切除3又3/4个甲状旁腺以及继发性甲状旁腺增生行甲状旁腺全切除加甲状旁腺自体移植是首选的治疗方法，这本来可以避免该组患者再次手术。仔细的颈部探查、切除胸腺，甚至甲状腺切除术可能会找到遗漏的甲状旁腺腺瘤。初次手术时不应进行纵隔切开术。对所有甲状腺手术患者进行仔细的病史询问以及术前血钙和血磷测定将发现隐匿性甲状旁腺功能亢进。在我们整个甲状旁腺病例系列中，共识别出21例此类患者。
