Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.
Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.
Sci Rep. 2020 Jun 30;10(1):10634. doi: 10.1038/s41598-020-67424-5.
Surgical excision is the preferred treatment for multiple endocrine neoplasia type 1 (MEN1)-related primary hyperparathyroidism (PHPT), although controversy regarding the surgical strategy exists. We retrospectively investigated the short-term outcomes of PHPT by various surgical extents. Thirty-three patients who underwent parathyroidectomy due to MEN1-related PHPT at Yonsei Severance Hospital between 2005 and 2018 were included (age [mean ± SD], 43.4 ± 14.1 [range, 23-81] years). Total parathyroidectomy with auto-transplantation to the forearm (TPX) was the most common surgical method (17/33), followed by less-than-subtotal parathyroidectomy (LPX; 12/33) and subtotal parathyroidectomy (SPX; 4/33). There was no postoperative persistent hyperparathyroidism. Recurrence was high in the LPX group without significance (1 in TPX, 2 in SPX, and 3 in LPX, p = 0.076). Permanent and transient hypoparathyroidism were more common in TPX (n = 6/17, 35.3%, p = 0.031; n = 4/17, 23.5%, p = 0.154, respectively). Parathyroid venous sampling (PVS) was introduced in 2013 for preoperative localisation of hyperparathyroidism at our hospital; nine among 19 patients operated on after 2013 underwent pre-parathyroidectomy PVS, with various surgical extents, and no permanent hypoparathyroidism (p = 0.033) or post-LPX recurrence was observed. Although TPX with auto-transplantation is the standard surgery for MEN1-related PHPT, surgical extent individualisation is necessary, given the postoperative hypoparathyroidism rate of TPX and feasibility of PVS.
手术切除是治疗多发性内分泌腺瘤 1 型（MEN1）相关原发性甲状旁腺功能亢进症（PHPT）的首选方法，尽管关于手术策略仍存在争议。我们回顾性研究了不同手术范围的 PHPT 的短期结果。33 例因 MEN1 相关 PHPT 于 2005 年至 2018 年在延世大学Severance 医院行甲状旁腺切除术的患者被纳入研究（年龄[均值±标准差]，43.4±14.1[范围 23-81]岁）。甲状旁腺全切除+前臂自体移植（TPX）是最常见的手术方法（17/33），其次是次全甲状旁腺切除术（LPX；12/33）和全甲状腺切除术（SPX；4/33）。术后无持续性甲状旁腺功能亢进症。LPX 组的复发率较高，但无统计学意义（TPX 组 1 例，SPX 组 2 例，LPX 组 3 例，p=0.076）。TPX 组的永久性和暂时性甲状旁腺功能减退症更为常见（TPX 组 6/17，35.3%，p=0.031；TPX 组 4/17，23.5%，p=0.154）。我院于 2013 年开始引入甲状旁腺静脉采血（PVS）用于术前定位甲状旁腺亢进症；在 2013 年后接受手术的 19 例患者中，有 9 例行术前 PVS，行不同手术范围，无永久性甲状旁腺功能减退症（p=0.033）或 LPX 术后复发。尽管 TPX 联合自体移植是 MEN1 相关 PHPT 的标准手术，但鉴于 TPX 术后甲状旁腺功能减退症的发生率和 PVS 的可行性，需要对手术范围进行个体化。
