Bendinelli Cino, Gray Andrew, Suradi Hassan, Weber Dieter G, Acharya Shamasunder, Price Anna, McGrath Shaun
Department of General Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia.
Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia.
ANZ J Surg. 2018 Apr;88(4):E308-E312. doi: 10.1111/ans.13956. Epub 2017 Apr 21.
In patients with primary hyperparathyroidism (PHPT) and preoperative imaging suggesting a solitary parathyroid adenoma (SPA), focused parathyroidectomy is most often curative. Even so, large studies show up to 3% of patients experience persistent or recurrent PHPT. Unilateral neck exploration (UNE) aiming to identify the SPA and the other ipsilateral parathyroid may reduce this failure rate. We hypothesized that: (i) minimally invasive video-assisted (MIVA) approach would facilitate UNE and (ii) this would be a clinically relevant strategy.
Prospective case series of a consecutive cohort of PHPT patients (with preoperative diagnosis of SPA), who underwent MIVA-UNE. A 15 mm collar incision and endoscopic magnification were utilized to both excise the SPA and seek the ipsilateral parathyroid gland.
From 2009 to 2014, 132 patients were offered MIVA-UNE (age: 63.0 (interquartile range: 11.2); females: 94 (71.2%); symptomatic: 89 (67.4%); mean serum corrected calcium: 2.7 (standard deviation: 0.9) mmol/L; mean serum parathyroid hormone: 16.8 (standard deviation: 11.8) pmol/L). Conversion from MIVA-UNE to open UNE was required in 14 (10.6%) patients (excluded from subsequent analysis). MIVA-UNE was concluded in 118 patients. The second ipsilateral parathyroid was identified in 62 (52.5%) patients and in 13 (11.0%) it appeared enlarged and was excised. Histopathology confirmed five (4.2%) of these glands to be hyperplastic.
MIVA-UNE allows identification of the second ipsilateral parathyroid in about half the patients. This approach helped to diagnose and treat unexpected multigland disease in almost 5% of patients.
在原发性甲状旁腺功能亢进症（PHPT）患者中，术前影像学检查提示为孤立性甲状旁腺腺瘤（SPA），聚焦甲状旁腺切除术通常可治愈。即便如此，大型研究表明，高达3%的患者会出现持续性或复发性PHPT。旨在识别SPA和同侧另一个甲状旁腺的单侧颈部探查（UNE）可能会降低这一失败率。我们假设：（i）微创视频辅助（MIVA）方法将有助于UNE，且（ii）这将是一种具有临床相关性的策略。
对连续一组接受MIVA-UNE的PHPT患者（术前诊断为SPA）进行前瞻性病例系列研究。采用15毫米领口切口和内镜放大技术切除SPA并寻找同侧甲状旁腺。
2009年至2014年，132例患者接受了MIVA-UNE（年龄：63.0（四分位间距：11.2）；女性：94例（71.2%）；有症状者：89例（67.4%）；平均血清校正钙：2.7（标准差：0.9）mmol/L；平均血清甲状旁腺激素：16.8（标准差：11.8）pmol/L）。14例（10.6%）患者需要从MIVA-UNE转为开放性UNE（后续分析中排除）。118例患者完成了MIVA-UNE。62例（52.5%）患者识别出了同侧第二个甲状旁腺，其中13例（11.0%）甲状旁腺肿大并被切除。组织病理学证实其中5例（4.2%）腺体为增生性。
MIVA-UNE能在约半数患者中识别出同侧第二个甲状旁腺。该方法有助于在近5%的患者中诊断和治疗意外的多腺体疾病。
