Zhang Wan-Chen, Lu Dong-Ning, Xu Jia-Jie, Guo Hai-Wei, Ge Ming-Hua, Zheng Chuan-Ming
Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.
Otolaryngology / Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital (Affliated People's Hospital, Hangzhou Medical College), Hangzhou, China.
Front Surg. 2022 Sep 22;9:962463. doi: 10.3389/fsurg.2022.962463. eCollection 2022.
To investigate the safety and feasibility of gasless axillary parathyroid surgery in the treatment of primary hyperparathyroidism.
A total of 12 patients who received gasless axillary parathyroidectomy (endoscope group) and 14 patients who received traditional open parathyroidectomy (open group) from January 2019 to April 2022 were screened and included. The differences in baseline characteristics, surgical efficiency, incidence rate of complications, changes in biochemical indicators, and incision satisfaction between the two groups were analyzed and compared.
The proportion of young patients was higher in the endoscopic group than in the open group, and the difference was statistically significant [(41.33 ± 13.65) years vs. (58.00 ± 9.44) years, < 0.01]. The differences in operation time, intra-operative blood loss, post-operative drainage volume, hospital stay, and surgical efficiency between the two groups yielded no statistical significance ( > 0.05). Patients in the open group had more significant neck pain 3 days after surgery ( = 0.046), but the degree of pain 3 months after surgery was the same in the 2 groups ( = 0.432). Evaluation of post-operative mature stage scar and incision satisfaction regarding aesthetics in the endoscope group were significantly superior to that in the open group [(1.92 ± 0.92) points vs. (0.92 ± 1.00) points, = 0.017 and (1.57 ± 0.51) points vs. (1.00 ± 0.013) points, = 0.013, respectively]. No statistical significance was found in terms of incidence rate of post-operative fever ( > 0.05). No temporary recurrent laryngeal nerve injury, post-operative bleeding, incision hematoma infection, or other complications were observed. Comparing the two groups, the extent of the level decrease of PTH was similar to that of serum calcium and phosphorus ( < 0.05), where most patients experienced transient hypocalcemia after operation yielding no significant difference in incidence ( = 0.225). During a follow-up period of 3 to 36 months, a total of 1 patient in the open group experienced recurrence at 10 months after surgery and was treated non-surgically.
Gasless axillary approach to parathyroid surgery for primary hyperparathyroidism possesses good safety and patient satisfaction in terms of aesthetics.
探讨免气腹腋窝入路甲状旁腺手术治疗原发性甲状旁腺功能亢进症的安全性和可行性。
筛选并纳入2019年1月至2022年4月期间接受免气腹腋窝甲状旁腺切除术的12例患者（内镜组）和接受传统开放性甲状旁腺切除术的14例患者（开放组）。分析比较两组患者的基线特征、手术效率、并发症发生率、生化指标变化及切口满意度。
内镜组年轻患者比例高于开放组，差异有统计学意义[（41.33±13.65）岁 vs.（58.00±9.44）岁，P<0.01]。两组患者手术时间、术中出血量、术后引流量、住院时间及手术效率比较，差异无统计学意义（P>0.05）。开放组患者术后3天颈部疼痛更明显（P=0.046），但术后3个月两组疼痛程度相同（P=0.432）。内镜组术后成熟阶段瘢痕及切口美学满意度评估明显优于开放组[（1.92±0.9）分 vs.（0.92±1.0）分，P=0.017；（1.57±0.51）分 vs.（1.00±0.13）分，P=0.013]。术后发热发生率比较，差异无统计学意义（P>0.05）。未观察到暂时性喉返神经损伤、术后出血、切口血肿感染或其他并发症。两组比较，甲状旁腺激素（PTH）水平下降程度与血清钙、磷相似（P<0.05），多数患者术后出现短暂性低钙血症，发生率差异无统计学意义（P=0.225）。随访3至36个月，开放组共有1例患者术后10个月复发，采用非手术治疗。
免气腹腋窝入路甲状旁腺手术治疗原发性甲状旁腺功能亢进症具有良好的安全性，患者对美观方面的满意度较高。
