Worsey M J, Carty S E, Watson C G
Department of Surgery, University of Pittsburgh School of Medicine, Pa.
Surgery. 1993 Dec;114(6):1024-9; discussion 1029-30.
Unilateral neck exploration for primary hyperparathyroidism (PHPTH) is controversial because of concern about missed multiglandular disease.
In patients with sporadic PHPTH our approach has been arbitrarily to surgically explore the right neck first unless preoperative or intraoperative evidence suggests left-sided parathyroid pathologic condition. When an adenoma is identified and a normal ipsilateral gland is confirmed on histologic examination, the contralateral side is not explored. A 15-year series of 371 patients with sporadic PHPTH was reviewed retrospectively to determine the efficacy of this strategy.
At operation unilateral exploration was possible in 125 patients (34%). Of these 122 had a single adenoma and two patients had parathyroid carcinoma. One patient with unrecognized hyperplasia required subsequent subtotal parathyroidectomy. There were no major complications. Bilateral surgical exploration was required in 246 patients including 18 with hyperplasia, 4 with double adenomas, and 4 with parathyroid cancer. Bilateral surgical exploration failed in 18 patients (14 persistent and 4 recurrent PHPTH) and was complicated by one recurrent nerve palsy and two cases of permanent hypocalcemia. Operative time was significantly shorter in the unilaterally explored group.
When possible, unilateral exploration for PHPTH is safe and effective, avoids obliterative scarring of the contralateral neck, and may reduce morbidity and operative time.
由于担心遗漏多腺体疾病，原发性甲状旁腺功能亢进症（PHPTH）的单侧颈部探查存在争议。
对于散发性PHPTH患者，我们的方法是除非术前或术中证据提示左侧甲状旁腺病变，否则一律先手术探查右侧颈部。当发现腺瘤且组织学检查证实同侧腺体正常时，不对对侧进行探查。回顾性分析371例散发性PHPTH患者的15年系列病例，以确定该策略的有效性。
手术中125例患者（34%）可行单侧探查。其中122例有单个腺瘤，2例有甲状旁腺癌。1例未识别出增生的患者随后需要进行甲状旁腺次全切除术。无重大并发症。246例患者需要双侧手术探查，包括18例增生、4例双腺瘤和4例甲状旁腺癌。双侧手术探查失败18例（14例持续性和4例复发性PHPTH），并伴有1例喉返神经麻痹和2例永久性低钙血症。单侧探查组的手术时间明显较短。
对于PHPTH，尽可能进行单侧探查是安全有效的，可避免对侧颈部的瘢痕形成，并可能降低发病率和手术时间。
