Nastos K, Constantinides V, Mizamtsidi M, Duncan N, Tolley N, Palazzo F
Department of Endocrine and Thyroid Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital , London , UK.
Department of Endocrinology, Imperial College Healthcare NHS Trust, Hammersmith Hospital , London , UK.
Ann R Coll Surg Engl. 2018 Jul;100(6):436-442. doi: 10.1308/rcsann.2018.0032.
Introduction Parathyroidectomy is considered to be a safe procedure with low morbidity. However, while this is true for primary hyperparathyroidism, whether it applies to tertiary disease is not so well documented. The aim of this study was to assess the morbidity of surgery for tertiary hyperparathyroidism compared with primary disease and to establish whether there are predictive factors for poor outcomes. Methods Data for patients subjected to parathyroidectomy during the period 2007-2015 were retrospectively analysed from a prospectively collected database. Patient age, sex, American Society of Anesthesiologists (ASA) score, renal status, extent of operation and indications for surgery were examined. The complication and mortality rate were compared and independent predictors of outcome were examined. Results A total of 1079 patients were scheduled for a parathyroidectomy during the study period of whom 158 for renal related hyperparathyroidism (renal group) and 921 for primary disease (non-renal group). There was a significantly higher complication rate in the renal parathyroid group, including a higher mortality (1.3% vs 0.1%, P = 0.011), overall complication rate (7.0% vs 2.3%, P = 0.001), surgery related complication rate (4.4% vs 1.7%, P = 0.03) and systemic complication rate (2.5% vs 0.4%, P = 0.005). In patients with ASA score ≤ 2 reoperative surgery (OR 9.25, 95% confidence interval, CI 1.41-60.75), male sex (OR 4.12, 95% CI 1.46-11.63) and renal impairment were (OR 5.86, 95% CI 1.65-20.78) were predictors of worse outcomes. In patients with ASA score ≥3 renal impairment, in addition to other variables, were not predictors of complications. Conclusions Parathyroidectomy in renal-related disease is associated with a significantly higher risk of morbidity and mortality compared with primary hyperparathyroidism.
引言 甲状旁腺切除术被认为是一种安全的手术，发病率较低。然而，虽然原发性甲状旁腺功能亢进症确实如此，但这是否适用于三发性疾病，相关记录并不完善。本研究的目的是评估三发性甲状旁腺功能亢进症手术与原发性疾病相比的发病率，并确定是否存在预后不良的预测因素。方法 回顾性分析2007年至2015年期间接受甲状旁腺切除术患者的数据，这些数据来自一个前瞻性收集的数据。检查患者的年龄、性别、美国麻醉医师协会（ASA）评分（译者注：原文为“美国麻醉医师协会（ASA）评分”，实际是指美国麻醉医师协会身体状况分级标准，是对患者术前病情和体质状况的一种评估方法）、肾脏状况、手术范围和手术指征。比较并发症和死亡率，并检查预后的独立预测因素。结果 在研究期间，共有1079例患者计划接受甲状旁腺切除术，其中158例为肾性甲状旁腺功能亢进症患者（肾病组），921例为原发性疾病患者（非肾病组）。肾病组的并发症发生率显著更高，包括更高的死亡率（1.3%对0.1%，P = 0.011）、总体并发症发生率（7.0%对2.3%，P = 0.001）、手术相关并发症发生率（4.4%对1.7%，P = 0.03）和全身并发症发生率（2.5%对0.4%，P = 0.005）。在ASA评分≤2的患者中，再次手术（比值比[OR]9.25，95%置信区间[CI]1.41 - 60.75）、男性（OR 4.12，95% CI 1.46 - 11.63）和肾功能损害（OR 5.86，95% CI 1.65 - 20.78）是预后较差的预测因素。在ASA评分≥3的患者中，除其他变量外，肾功能损害不是并发症的预测因素。结论 与原发性甲状旁腺功能亢进症相比，肾性疾病患者进行甲状旁腺切除术的发病率和死亡率风险显著更高。
