Yadav Sanjay K, Mishra Saroj K, Mishra Anjali, Mayilvagnan Sabaretnam, Chand Gyan, Agarwal Gaurav, Agarwal Amit, Verma Ashok K
Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India.
Indian J Endocrinol Metab. 2019 Jul-Aug;23(4):468-472. doi: 10.4103/ijem.IJEM_255_19.
Despite the benefits of focused parathyroidectomy (FPTx), few studies have questioned its durability with lower long-term cure rates than bilateral or conventional parathyroidectomy (CPTx). The objective of this study is to bring out the information on the type of surgical management versus cure rate, recurrence, and role of intra-operative parathyroid hormone (IOPTH) level monitoring of PHPT patients.
This was a retrospective study of all PHPT patients treated at our center based on operative approach (CPTx vs FPTx) or use of IOPTH. Treatment failure was divided into persistent or recurrent disease, based on documentation of hypercalcemia in combination with an inappropriate PTH within 6 months or more of surgery, respectively.
Overall, 50.78% patients underwent CPTx and 49.32% FPTx. 29 FPTx were converted to CPTx. Intention to treat analysis between CPTx and FPTx showed that the persistence rate was not statistically different at 2.54% and 4%, respectively ( = 0.98). Furthermore, when the persistence rate was scrutinized by a treatment received (TR) instead of ITT analysis, the persistence rate was higher for the patients who underwent TR-CPTX than for the patients subjected to TR-FPTX (3.22% vs 1.08%) but not significant statistically. We further analyzed the outcome of FPTx with IOPTH ( = 213) and FPTx without IOPTH ( = 28). The outcome did not differ between two groups statistically.
FPTx yields a similar success rate as compared to CPTx even in symptomatic PHPT patients and can be performed safely even without intra-opeartive adjunct IOPTH in selected patients.
尽管聚焦甲状旁腺切除术（FPTx）有诸多益处，但很少有研究质疑其持久性，因为其长期治愈率低于双侧或传统甲状旁腺切除术（CPTx）。本研究的目的是揭示甲状旁腺功能亢进症（PHPT）患者手术管理类型与治愈率、复发率以及术中甲状旁腺激素（IOPTH）水平监测作用的相关信息。
这是一项对在我们中心接受治疗的所有PHPT患者进行的回顾性研究，基于手术方式（CPTx与FPTx）或IOPTH的使用情况。治疗失败分为持续性或复发性疾病，分别根据手术后6个月或更长时间内高钙血症合并不适当甲状旁腺激素（PTH）的记录来判断。
总体而言，50.78%的患者接受了CPTx，49.32%接受了FPTx。29例FPTx转为CPTx。CPTx和FPTx之间的意向性治疗分析表明，持续性比率分别为2.54%和4%，无统计学差异（P = 0.98）。此外，当按接受的治疗（TR）而非意向性治疗（ITT）分析来仔细审查持续性比率时，接受TR-CPTX的患者的持续性比率高于接受TR-FPTX的患者（3.22%对1.08%），但无统计学意义。我们进一步分析了使用IOPTH的FPTx（n = 213）和未使用IOPTH的FPTx（n = 28）的结果。两组结果在统计学上无差异。
即使在有症状的PHPT患者中，FPTx与CPTx的成功率相似，并且在选定的患者中，即使不使用术中辅助手段IOPTH也可安全进行。
