Demir Berat, Binnetoglu Adem, Sahin Akın, Yavuz Dilek Gogas
Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Istanbul, Turkey.
Department of Otorhinolaryngology-Head and Neck Surgery, St. Elizabeth's Medical Center, Brighton, MA, USA.
Clin Exp Otorhinolaryngol. 2020 Aug;13(3):285-290. doi: 10.21053/ceo.2019.01361. Epub 2020 Jul 11.
As calcium included as a part of routine laboratory screening early diagnosis of primary hyperparathyroidism (PHPT) has been increased. Surgical resection of parathyroid adenoma or hyperplasia still is the mainstay of the treatment for most PHPT patients. The aim of this study was to evaluate of the surgical outcomes of patients with PHPT that referred to our ENT department of our University Hospital for the last 6 years.
One hundred thirty-seven patients with PHPT who underwent parathyroid surgery in our clinic between October 2011 and January 2018 included in this retrospective study. Data on demographics, clinical findings, past medical history, preoperative laboratory values in 3 months, preoperative localizing imaging studies including ultrasonography (USG) and 99mTc-sestamibi (methoxyisobutyl isonitrile, [MIBI]) scan, operative findings, postoperative laboratory values, and pathology reports were recorded. MIBI scan and USG are used as the first-line modalities in our center. Single-photon emission computed tomography was used for challenging situations of re-exploration and ectopic parathyroid pathology. Four-dimensional computed tomography scanning is was preferred as the last imaging modality. Focused unilateral neck exploration (FUNE) was performed with intraoperative frozen section analysis as a routine procedure. Bilateral neck exploration (BNE) was used only in re-exploration, ectopic parathyroid, and with high suspicion of multigland disease.
Totally 137 patients (female:male, 3:3; mean age, 54.6±13.2 years) included in the study. Single parathyroid adenoma was found in 108 patients (78.8%). Most common adenoma localization was left inferior parathyroid gland (46.7%). FUNE was performed in 89.8% of the patients and BNE for 10.2% of the patients. Postoperative normocalcemia was reached in 132 patients and permanent hypocalcemia was observed in two patients. Persistence hypercalcemia observed in three patients. Postoperative pathology reports revealed three patients have parathyroid carcinoma.
Preoperative imaging modalities is very important in parathyroidectomy surgery. Routine use of preoperative imaging modalities reduced the risk of complications in our clinic.
由于钙作为常规实验室筛查的一部分，原发性甲状旁腺功能亢进症（PHPT）的早期诊断有所增加。甲状旁腺腺瘤或增生的手术切除仍是大多数PHPT患者治疗的主要方法。本研究的目的是评估过去6年转诊至我校医院耳鼻喉科的PHPT患者的手术结果。
本回顾性研究纳入了2011年10月至2018年1月期间在我院接受甲状旁腺手术的137例PHPT患者。记录了人口统计学、临床发现、既往病史、术前3个月的实验室值、术前定位影像学检查（包括超声检查（USG）和99mTc-甲氧基异丁基异腈（MIBI）扫描）、手术发现、术后实验室值和病理报告。MIBI扫描和USG在我们中心用作一线检查方法。单光子发射计算机断层扫描用于再次探查和异位甲状旁腺病变的疑难情况。四维计算机断层扫描作为最后的影像学检查方法。常规进行聚焦单侧颈部探查（FUNE）并进行术中冰冻切片分析。双侧颈部探查（BNE）仅用于再次探查、异位甲状旁腺以及高度怀疑多腺体疾病的情况。
本研究共纳入137例患者（女性：男性为3：3；平均年龄54.6±13.2岁）。108例患者（78.8%）发现单发甲状旁腺腺瘤。最常见的腺瘤定位是左下甲状旁腺（46.7%）。89.‘8%的患者进行了FUNE，10.2%的患者进行了BNE。132例患者术后血钙正常，2例患者出现永久性低钙血症。3例患者持续性高钙血症。术后病理报告显示3例患者患有甲状旁腺癌。
术前影像学检查在甲状旁腺切除术中非常重要。术前影像学检查的常规使用降低了我院并发症的风险。
