Ryan Stephen, Courtney Danielle, Moriariu Julia, Timon Conrad
Departments of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin 2, Ireland.
Departments of Otolaryngology, St James's University Hospital, Dublin, Ireland.
Eur Arch Otorhinolaryngol. 2017 Dec;274(12):4225-4232. doi: 10.1007/s00405-017-4776-4. Epub 2017 Oct 16.
We reviewed the surgical management of primary hyperparathyroidism through a retrospective chart review of 200 parathyroidectomy procedures performed over a 12 year period. Epidemiological data and accuracy of radiological investigations used in identifying pathological parathyroid tissue location were assessed. We determined how often simultaneous removal of thyroid tissue was required during parathyroidectomy and the associated pathology. Radiology reports were screened to determine if confirmed thyroid pathology from histological specimens were referenced pre-operatively. Open parathyroid surgery was performed in 71%, the remainder endoscopically. 95% of parathyroid specimens were confirmed as benign adenomas, with eight cases of hyperplasia and two parathyroid carcinomas. Pre-operative ultrasound and SPECT-CT imaging demonstrated sensitivity of 55% and 73% respectively with regards correct adenoma localisation. Forty-nine patients (25%) underwent simultaneous partial thyroidectomy, 45 (92%) with dual pathology confirmed. Malignant thyroid lesions were identified in 18% (n = 8), Graves' disease 2% (n = 1), thyroiditis 9% (n = 4), multinodular goitre 56% (n = 25), unilateral nodule 4% (n = 2), hyperplasia 7% (n = 3) and intra-thyroid adenoma 4% (n = 2). Reference to these thyroid lesions was made in only 36% of preoperative imaging reports. In conclusion, synchronous thyroid surgery was carried out in a quarter of all parathyroidectomy procedures performed for treatment of primary hyperparathyroidism. Coincidental thyroid pathology was common. The limitations of pre-operative imaging in reliably locating involved parathyroid tissue are demonstrated and the importance of considering the potential need to perform thyroid surgery during parathyroidectomy and obtaining appropriate informed consent.
我们通过对12年间进行的200例甲状旁腺切除术的病历进行回顾性分析，对原发性甲状旁腺功能亢进症的外科治疗进行了研究。评估了流行病学数据以及用于确定病理性甲状旁腺组织位置的放射学检查的准确性。我们确定了甲状旁腺切除术中同时切除甲状腺组织的频率以及相关病理情况。筛查放射学报告以确定术前是否提及组织学标本证实的甲状腺病理情况。71%的患者接受了开放性甲状旁腺手术，其余患者接受了内镜手术。95%的甲状旁腺标本被确认为良性腺瘤，8例为增生，2例为甲状旁腺癌。术前超声和SPECT-CT成像对正确腺瘤定位的敏感性分别为55%和73%。49例患者（25%）同时接受了部分甲状腺切除术，其中45例（92%）证实存在双重病理情况。18%（n = 8）的患者发现有甲状腺恶性病变，2%（n = 1）为格雷夫斯病，9%（n = 4）为甲状腺炎，56%（n = 25）为多结节性甲状腺肿，4%（n = 2）为单侧结节，7%（n = 3）为增生，4%（n = 2）为甲状腺内腺瘤。仅36%的术前影像学报告提及了这些甲状腺病变。总之，在所有因原发性甲状旁腺功能亢进症而进行的甲状旁腺切除术中，四分之一的患者同时进行了甲状腺手术。巧合的甲状腺病理情况很常见。研究表明了术前成像在可靠定位受累甲状旁腺组织方面的局限性，以及在甲状旁腺切除术中考虑潜在的甲状腺手术需求并获得适当知情同意的重要性。
