Gloucester Royal Hospital ENT Department, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
Bristol Royal Infirmary ENT Department, University Hospital Bristol and Weston NHS Trust, Bristol, UK.
World J Surg. 2024 Oct;48(10):2463-2470. doi: 10.1002/wjs.12329. Epub 2024 Sep 19.
The United Kingdom Registry of Endocrine and Thyroid Surgery (UKRETS) holds the largest database of pediatric parathyroidectomy cases globally. There are currently no quoted acceptable cure or complication rates in the literature.
This retrospective database analysis evaluates the efficacy and safety of targeted parathyroidectomy (tPTx) and bilateral neck exploration (BNE) in first-time parathyroidectomy for pediatric primary hyperparathyroidism (PHPT) through analysis of the UKRETS database (1995-2022). Pre-, intra- and postoperative outcomes were assessed and analyzed.
168 cases underwent parathyroidectomy; 25 (15%) familial and 143 (85%) sporadic PHPT. 69% were female with a mean age of 10 years (Range 0-17). BNE was the most common operative approach (61%; n = 103/168). The most frequently used imaging modality was US (80%; n = 135/168). Mean number of glands excised in familial cases was three compared to one gland in sporadic cases (p < 0.05). Familial cases had a significantly higher rate of postoperative hypocalcemia (32% vs. 9%, p < 0.05) and all were BNE. Cure rate was 96.9% (n = 127/131), with differences in cure rates that did not reach statistical significance (sporadic 98.2% vs. familial 90.5%, p = 0.06). Preoperative localization (image-positive or negative) made no difference to cure rates in either familial (90% vs. 91%, p = 0.94) or sporadic (97.5% vs. 100%, p = 0.4) cases.
This analysis demonstrates that first-time pediatric parathyroidectomy for PHPT is safe and effective. Familial cases have a higher rate of postoperative hypocalcemia; therefore, parents should be informed of this when consented. Targeted parathyroidectomy is safe and effective in both sporadic and familial cases, as long as there is positive preoperative imaging.
英国内分泌和甲状腺外科登记处（UKRETS）拥有全球最大的儿科甲状旁腺切除术病例数据库。目前，文献中没有引用可接受的治愈率或并发症发生率。
本回顾性数据库分析通过分析 UKRETS 数据库（1995-2022 年），评估儿童原发性甲状旁腺功能亢进症（PHPT）首次甲状旁腺切除术时靶向甲状旁腺切除术（tPTx）和双侧颈部探查（BNE）的疗效和安全性。评估和分析了术前、术中及术后结果。
168 例患者行甲状旁腺切除术；25 例（15%）为家族性，143 例（85%）为散发性 PHPT。69%为女性，平均年龄 10 岁（范围 0-17 岁）。BNE 是最常见的手术方法（61%；n=103/168）。最常用的影像学方法是 US（80%；n=135/168）。家族性病例中切除的腺体数量明显多于散发性病例（3 个对 1 个，p<0.05）。家族性病例术后低钙血症发生率明显较高（32%对 9%，p<0.05），且均为 BNE。治愈率为 96.9%（n=127/131），但治愈率差异无统计学意义（散发性 98.2%对家族性 90.5%，p=0.06）。术前定位（图像阳性或阴性）对家族性（90%对 91%，p=0.94）或散发性（97.5%对 100%，p=0.4）病例的治愈率均无影响。
本分析表明，儿童 PHPT 首次甲状旁腺切除术是安全有效的。家族性病例术后低钙血症发生率较高；因此，在获得知情同意时，应告知家长。只要有阳性术前影像学检查，靶向甲状旁腺切除术在散发性和家族性病例中均安全有效。
