Astl J, Hložek J, Holý R, Rotnágl J
Rozhl Chir. 2021 Spring;100(3):126-132. doi: 10.33699/PIS.2021.100.3.126-132.
The incidence of parathyroid - glandula parathyreoideae (PTG) diseases has been increasing worldwide. Unlike benign tumours, the incidence of malignant PTG tumours is rather a rare diagnosis. The morbidity of parathyroid surgery is associated with surgical removal of one or more pathologically altered parathyroid glands, particularly parathyroid adenoma associated with primary hyperparathyroidism (HPPT), but also hyperplasia associated with secondary or tertiary HPPT, and last but not least, HPPT due to parathyroid cancer.
A retrospective statistical analysis was performed in the set of patients undergoing surgery for a parathyroid disorder at the Department of Otorhinolaryngology and Maxillofacial Surgery, 3rd Faculty of Medicine, Charles University and Military University Hospital in Prague in 2013-2019 (7-year period). In this period, 127 procedures were performed. The incidences of morbidity, mortality, complications and lethality were analysed.
Parathyroid surgery was performed in 20 male and 107 female patients. The mean age was 54.7 years, and the morbidity expressing recurrent laryngeal nerve (RLN) palsy was 0.7% of the nerves exposed during the procedure. The incidence of permanent normal postoperative calcaemia was 98.43%, demonstrated by a decrease in serum parathyroid hormone (PTH) levels. In 12 cases, this state was achieved only after a surgical revision (primary procedure for primary HPPT in 2 cases; 10 patients came for surgical revision with secondary or tertiary HPPT from other centres). Decreased PTH levels were demonstrated intraoperatively in 12.6% patients using the so-called PTH assay (a rapid serum PTH assay). Surgery for secondary or tertiary hyperparathyroidism was done in 33 patients (26% procedures). PTG surgery lethality (mortality) was divided into perioperative mortality within 24 hours from the procedure and early mortality within 120 hours. Lethality related to PTG surgery was 0.0% including patients undergoing the surgery while being in a dialysis programme and those with kidney transplant.
Surgery is always associated with complications, with morbidity and mortality. Experience of endocrinology surgeons of all specialties is reflected in a very low incidence of RLN injuries and in sufficient oncological, or respectively, surgical radicality. This, in connection with other medical fields of endocrinology, nephrology, transplantology, nuclear medicine and oncology, allows a safe and effective treatment of all PTG disorders with a good prognosis for the patients. In those with secondary or tertiary HPPT, it not only improves their quality of life, which was not explored in our study, but in many cases it is an essential step for listing the patient for the transplant surgery. The current level of experience in the field of parathyroid carcinoma does not enable us to formulate any conclusions in terms of prognosis which should be considered as very serious in all cases.
甲状旁腺疾病的发病率在全球范围内呈上升趋势。与良性肿瘤不同，甲状旁腺恶性肿瘤的发病率相对罕见。甲状旁腺手术的发病率与手术切除一个或多个病理改变的甲状旁腺有关，特别是与原发性甲状旁腺功能亢进（HPPT）相关的甲状旁腺腺瘤，也与继发性或三发性HPPT相关的增生有关，最后但同样重要的是，与甲状旁腺癌导致的HPPT有关。
对2013 - 2019年（7年期间）在布拉格查理大学医学院第三附属医院和军事大学医院耳鼻喉科和颌面外科接受甲状旁腺疾病手术的患者进行回顾性统计分析。在此期间，共进行了127例手术。分析了发病率、死亡率、并发症和致死率。
甲状旁腺手术患者中男性20例，女性107例。平均年龄为54.7岁，术中喉返神经（RLN）麻痹的发病率为所暴露神经的0.7%。术后永久性血钙正常的发生率为98.43%，表现为血清甲状旁腺激素（PTH）水平下降。在12例患者中，这种状态仅在手术修正后才实现（2例原发性HPPT的初次手术；10例患者因继发性或三发性HPPT从其他中心前来进行手术修正）。术中使用所谓的PTH检测（快速血清PTH检测），12.6%的患者PTH水平下降。33例患者（占手术的26%）接受了继发性或三发性甲状旁腺功能亢进的手术。甲状旁腺手术致死率（死亡率）分为术后24小时内的围手术期死亡率和120小时内的早期死亡率。与甲状旁腺手术相关的致死率为0.0%，包括正在接受透析治疗的患者和接受肾移植的患者。
手术总是伴随着并发症、发病率和死亡率。所有专科内分泌外科医生的经验体现在喉返神经损伤的发生率极低以及足够的肿瘤学或手术根治性方面。这与内分泌学、肾脏病学、移植学、核医学和肿瘤学等其他医学领域相结合，使得能够对所有甲状旁腺疾病进行安全有效的治疗，患者预后良好。对于继发性或三发性HPPT患者，它不仅改善了他们的生活质量（本研究未探讨），而且在许多情况下，这是将患者列入移植手术名单的关键步骤。目前甲状旁腺癌领域的经验水平使我们无法就预后得出任何结论，在所有情况下都应将其视为非常严重的情况。
