胸腔镜下切除肿大的纵隔甲状旁腺
Thoracoscopic excision of enlarged mediastinal parathyroid glands.
作者信息
Prinz R A, Lonchyna V, Carnaille B, Wurtz A, Proye C
机构信息
Department of General Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Ill 60612.
出版信息
Surgery. 1994 Dec;116(6):999-1004; discussion 1004-5.
BACKGROUND
Most abnormal parathyroid glands can be removed through the neck, but those deep in the chest have required sternotomy or thoracotomy. To avoid the morbidity of these open procedures, ectopic parathyroid glands deep in the chest were removed with video-assisted thoracoscopy.
METHODS
Two patients with persistent primary and two with persistent secondary hyperparathyroidism had technetium-thallium scintigraphy and computed tomography of the chest to localize their ectopic glands. Video-assisted thoracoscopy was used for operative removal of these glands in each patient.
RESULTS
Parathyroid scans identified a mediastinal gland that was confirmed and localized precisely by the computed tomography scan. An enlarged ectopic gland weighing 1 to 2 gm was removed from each patient with normalization of serum calcium level. Glands were found by the main pulmonary artery, aortopulmonary window, ascending aorta, and aortic arch. One patient had recurrent disease 9 months later.
CONCLUSIONS
Removal of parathyroid glands deep in the chest with video-assisted thoracoscopy is a safe and successful alternative to median sternotomy.
背景
大多数异常甲状旁腺可通过颈部切除，但位于胸腔深部的甲状旁腺则需要进行胸骨切开术或开胸手术。为避免这些开放性手术带来的并发症，采用电视辅助胸腔镜切除胸腔深部的异位甲状旁腺。
方法
两名原发性甲状旁腺功能亢进症持续不缓解患者和两名继发性甲状旁腺功能亢进症持续不缓解患者接受了锝-铊闪烁扫描及胸部计算机断层扫描，以定位其异位甲状旁腺。对每名患者均采用电视辅助胸腔镜手术切除这些甲状旁腺。
结果
甲状旁腺扫描发现一个纵隔甲状旁腺，计算机断层扫描准确地对其进行了确认和定位。从每名患者体内切除了一个重1至2克的肿大异位甲状旁腺，血清钙水平恢复正常。甲状旁腺位于主肺动脉、主动脉肺动脉窗、升主动脉和主动脉弓附近。一名患者在9个月后疾病复发。
结论
采用电视辅助胸腔镜切除胸腔深部的甲状旁腺是一种安全、成功的替代正中胸骨切开术的方法。
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