University of Alabama at Birmingham, Department of Surgery, USA.
University of Alabama at Birmingham, Department of Surgery, USA.
Am J Surg. 2021 Feb;221(2):485-488. doi: 10.1016/j.amjsurg.2020.11.027. Epub 2020 Nov 17.
Re-operative parathyroidectomy in patients with recurrent or persistent hyperparathyroidism can be challenging. We review our experience to determine the optimal number of localization studies prior to re-operation.
From 2001 to 2019, 251 patients underwent re-operative parathyroidectomy. Parathyroidectomies were stratified to 4 groups based upon the number of positive localization studies obtained: A) ZERO, B) 1-positive, C) 2-positive, D) 3-positive.
The overall cure rate was 97%, where 201 single gland resections, 23 two-gland resections, 22 subtotal/total, and 5 forearm autograft resections were performed. Thirty-two patients had no positive studies (A), 172 patients had 1-positive (B), 42 patients had 2-positive (C), and 5 patients had 3-positive studies (D). There was no difference in surgical cure rates between groups (p = 0.71). The majority of patients had one or no positive imaging studies yet almost all still achieved cure.
Successful re-operative parathyroidectomy can be performed with minimal pre-operative scans in certain clinical contexts.
对于复发性或持续性甲状旁腺功能亢进症患者，再次甲状旁腺切除术具有挑战性。我们回顾了我们的经验，以确定再次手术前进行定位研究的最佳次数。
从 2001 年到 2019 年，有 251 名患者接受了再次甲状旁腺切除术。根据获得的阳性定位研究数量，将甲状旁腺切除术分为 4 组：A）零，B）1 个阳性，C）2 个阳性，D）3 个阳性。
总治愈率为 97%，其中 201 例单腺叶切除术，23 例双腺叶切除术，22 例次全/全切除术，5 例前臂自体移植切除术。32 例患者无阳性研究（A），172 例患者有 1 个阳性（B），42 例患者有 2 个阳性（C），5 例患者有 3 个阳性研究（D）。各组之间的手术治愈率无差异（p=0.71）。大多数患者只有一项或没有阳性影像学研究，但几乎所有患者仍达到治愈。
在某些临床情况下，甲状旁腺功能亢进症再次手术时，术前扫描最少也能获得成功。
