Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
Scand J Surg. 2024 Sep;113(3):254-260. doi: 10.1177/14574969241228409. Epub 2024 Mar 4.
Studies on the outcomes of parathyroid surgery are scarce. The aim was to report the outcomes and to study the association between pre- and peri-operative information with the outcomes of patients operated for primary hyperparathyroidism.
This was a retrospective, descriptive study with unselected patients treated surgically for primary hyperparathyroidism from a catchment population of 704,500 in Finland. Data were acquired from the electronic hospital registers based on parathyroid surgery procedure codes between 1 January 2017 and 31 December 2018. Preoperative data, surgical data, preoperative and postoperative laboratory values, histopathological findings, and postoperative clinical data were recorded.
During the 2-year study period, 149 patients with primary hyperparathyroidism were treated surgically with a 97% remission rate. Surgical complications included postoperative bleeding in two patients (1%) and vocal cord paralysis in one patient (0.6%). No postoperative infections were reported. Three patients (2%) developed postoperative hypoparathyroidism necessitating the use of alfacalcidol more than 1 month after surgery. Ionized calcium measured 0-1 days after surgery was not statistically significantly associated with remission or postoperative hypoparathyroidism. Serum parathyroid hormone (PTH) assessed 0-1 days postoperatively was associated with persistent disease, but not with postoperative hypoparathyroidism. The histopathological diagnosis was adenoma or hyperplasia in 112 patients (75%), atypical adenoma in 28 patients (19%), and carcinoma in five patients (3%). Patients with parathyroid carcinoma had higher preoperative ionized calcium and PTH values than those with adenoma or hyperplasia.
Most patients who were operated due to primary hyperparathyroidism achieved normocalcemia after surgery, and the frequency of complications was low. Ionized calcium taken 0-1 days after surgery was not associated with remission of hyperparathyroidism or postoperative hypoparathyroidism. High postoperative serum PTH predicted persistent disease.
甲状旁腺手术结果的研究较为匮乏。本研究旨在报告手术结果，并探讨术前和围手术期信息与原发性甲状旁腺功能亢进症患者手术结果之间的关系。
这是一项回顾性、描述性研究，纳入了 2017 年 1 月 1 日至 2018 年 12 月 31 日期间，在芬兰一个 704500 人的人群中接受甲状旁腺手术的原发性甲状旁腺功能亢进症未选择患者。数据来源于电子病历系统中的甲状旁腺手术程序代码。记录了术前数据、手术数据、术前和术后实验室值、组织病理学发现以及术后临床数据。
在 2 年的研究期间，149 例原发性甲状旁腺功能亢进症患者接受了手术治疗，缓解率为 97%。手术并发症包括 2 例患者（1%）术后出血和 1 例患者（0.6%）声带麻痹。无术后感染报告。3 例患者（2%）在术后 1 个月以上需要使用骨化三醇，发生术后甲状旁腺功能减退症。术后 0-1 天测量的离子钙与缓解或术后甲状旁腺功能减退症无统计学相关性。术后 0-1 天测定的甲状旁腺激素（PTH）与持续性疾病相关，但与术后甲状旁腺功能减退症无关。112 例患者（75%）的组织病理学诊断为腺瘤或增生，28 例患者（19%）为不典型腺瘤，5 例患者（3%）为癌。甲状旁腺癌患者的术前离子钙和 PTH 值高于腺瘤或增生患者。
大多数因原发性甲状旁腺功能亢进症而接受手术的患者术后血钙恢复正常，并发症发生率较低。术后 0-1 天采集的离子钙与甲状旁腺功能亢进症的缓解或术后甲状旁腺功能减退症无关。高术后血清 PTH 提示持续性疾病。
