Zhu Guang-Wen, Lv Xue, Jiao Zhan
Thyroid Team, First Affiliated Hospital, Dalian Medical University, Dalian, China.
Department of Nuclear Medicine, First Affiliated Hospital, Dalian Medical University, Dalian, China.
Front Oncol. 2025 May 15;15:1535089. doi: 10.3389/fonc.2025.1535089. eCollection 2025.
Reducing the incidence rate of persistent/recurrent HPT after surgery is the key to the treatment of PHPT. The pitfalls of preoperative, intraoperative, and postoperative management in PHPT patients and their potential impact on surgical strategies need to be comprehensively investigated.
The demographic, biochemical, radiological results and other clinical data of the enrolled 112 patients with primary hyperparathyroidism undergoing surgical treatment were obtained from our database in this retrospective cohort study. One-way analysis of variance was used for normally distributed variables, and Kruskal-Wallis H test was used for non-normally distributed variables. Pearson's chi-square test or Fisher's exact test was used for categorical variables, as appropriate.
The patients were divided into parathyroid adenoma group and atypical parathyroid tumor + parathyroid carcinoma group. The serum calcium levels, serum PTH levels in the APT+PC group were higher than those with benign lesions, but there was some overlap; and the clinical data showed no specificity in the differentiation of benign and malignant parathyroid tumors. A more significant finding in this cohort was that the tumor size was significantly larger in persistent/recurrent HPT group than in non-persistent/recurrent group (30.0 ± 12.6 mm vs.19.1± 8.3 mm, p < 0.01).
In PHPT, there are pitfalls in preoperative, intraoperative, and postoperative management of parathyroid tumors, which affect the choice of surgical strategies. It is prudent to utilize the tumor-free margin En bloc resection in a variety of parathyroid neoplasms, in order to seek the chance of cure and avoid reoperation as much as possible.
降低手术后持续性/复发性甲状旁腺功能亢进症（HPT）的发病率是原发性甲状旁腺功能亢进症（PHPT）治疗的关键。需要全面研究PHPT患者术前、术中和术后管理中的陷阱及其对手术策略的潜在影响。
在这项回顾性队列研究中，从我们的数据库中获取了112例接受手术治疗的原发性甲状旁腺功能亢进症患者的人口统计学、生化、放射学结果及其他临床数据。对于正态分布变量，采用单因素方差分析；对于非正态分布变量，采用Kruskal-Wallis H检验。分类变量根据情况采用Pearson卡方检验或Fisher精确检验。
患者分为甲状旁腺腺瘤组和非典型甲状旁腺肿瘤+甲状旁腺癌组。非典型甲状旁腺肿瘤+甲状旁腺癌组的血清钙水平、血清甲状旁腺激素（PTH）水平高于良性病变组，但存在一定重叠；临床数据在甲状旁腺肿瘤良恶性鉴别上无特异性。该队列中一个更显著的发现是，持续性/复发性HPT组的肿瘤大小明显大于非持续性/复发性组（30.0±12.6mm对19.1±8.3mm，p<0.01）。
在PHPT中，甲状旁腺肿瘤的术前、术中和术后管理存在陷阱，影响手术策略的选择。对于各种甲状旁腺肿瘤，谨慎采用无瘤边缘整块切除，以寻求治愈机会并尽可能避免再次手术。
