THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA.
Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Laryngoscope. 2021 Aug;131(8):1915-1921. doi: 10.1002/lary.29489. Epub 2021 Mar 10.
OBJECTIVES/HYPOTHESIS: The primary objective of this study was to assess the safety of parathyroidectomy during pregnancy as treatment for hyperparathyroidism (HPTH) in comparison to nonsurgical management plans. Secondary outcomes involved analyzing the safety of surgery in the third trimester and the benefit of operating on asymptomatic pregnant patients.
Systematic review.
PRISMA-guided systematic review of all cases of primary hyperparathyroidism during pregnancy published in peer-reviewed English journals on PubMed/MEDLINE, EMBASE, and SCOPUS from 1980 to 2020.
A total of 75 manuscripts were included in this review describing 382 cases of gestational hyperparathyroidism. The median maternal age was 31 years. Overall, 108 cases (28.3%) underwent parathyroidectomy during pregnancy while 274 cases (71.7%) were treated nonsurgically. The majority of surgeries took place during the second trimester (67.6%). Complications and/or deaths were less likely to occur after surgery in the second trimester (4.48%) as compared to surgery in the third trimester (21.1%). Nine surgically treated cases resulted in infant complications and/or death; however, none of these nine cases had any surgical complications. Despite these complications, the overall infant complication rate for patients who underwent surgical treatment remained lower than that of patients treated with conservative therapy (9.1% vs. 38.9%).
This review suggests that for all pregnant patients with diagnosed HPTH, parathyroidectomy should be considered regardless of symptomatology. Our data suggest that parathyroidectomy is associated with fewer risks than more conservative treatments and results in better fetal outcomes. Surgery during the third trimester is feasible and surgery should be considered in both symptomatic and asymptomatic patients. Laryngoscope, 131:1915-1921, 2021.
目的/假设：本研究的主要目的是评估甲状旁腺切除术在妊娠期间作为治疗甲状旁腺功能亢进症（HPTH）的安全性，与非手术治疗方案相比。次要结果包括分析妊娠晚期手术的安全性以及对无症状妊娠患者进行手术的益处。
系统评价。
在 1980 年至 2020 年期间，使用 PubMed/MEDLINE、EMBASE 和 SCOPUS 等同行评审的英文期刊，对所有关于妊娠期间原发性甲状旁腺功能亢进症的病例进行了 PRISMA 指导的系统评价。
共有 75 篇文献纳入了本综述，描述了 382 例妊娠性甲状旁腺功能亢进症。产妇的中位年龄为 31 岁。总的来说，108 例（28.3%）在妊娠期间行甲状旁腺切除术，274 例（71.7%）接受非手术治疗。大多数手术发生在妊娠中期（67.6%）。与妊娠晚期手术相比（21.1%），妊娠中期手术后并发症和/或死亡的发生率较低（4.48%）。9 例手术治疗的病例导致婴儿并发症和/或死亡；然而，这 9 例病例均无手术并发症。尽管存在这些并发症，但接受手术治疗的患者的总体婴儿并发症发生率仍低于接受保守治疗的患者（9.1% vs. 38.9%）。
本综述表明，对于所有诊断为 HPTH 的妊娠患者，无论是否有症状，都应考虑甲状旁腺切除术。我们的数据表明，甲状旁腺切除术的风险低于更保守的治疗方法，并且会带来更好的胎儿结局。妊娠晚期手术可行，应考虑对有症状和无症状患者进行手术。喉科学，131：1915-1921，2021。
