Carter W B, Carter D L, Cohn H E
Department of Surgery, Jefferson Medical College, Philadelphia, Pennsylvania.
Am Surg. 1993 Feb;59(2):120-4.
We reviewed 137 cases of hyperparathyroidism followed for 6-72 months to determine the reasons for failure and to outline the successful management of reoperative hyperparathyroidism. Of 127 patients treated initially at Thomas Jefferson University Hospital, three required reoperation (2.4%) and 10 were referred with recurrent or persistent hyperparathyroidism. Reasons for failure were a missed gland in eight cases (62%), an ectopic gland in two cases (15%), supernumerary glands in two cases (15%), and malignant degeneration of an autotransplant in one case (8%). One patient had shortterm hypoparathyroidism requiring vitamin D supplementation (5.6%), but there were no injuries to the recurrent laryngeal nerves. We conclude that adequate knowledge of the location of normal and ectopic glands with meticulous search will reduce most reoperations, and, with identification of all four glands and routine cervical thymectomy in multigland disease, the rate should be less than 5 per cent. Patients requiring reoperation should undergo noninvasive localization studies and, if equivocal, selective venous sampling for parathyroid hormone. The major complication rate should be less than 10 per cent.
我们回顾了137例甲状旁腺功能亢进患者，随访6至72个月，以确定手术失败的原因，并概述再次手术治疗甲状旁腺功能亢进的成功管理方法。在最初于托马斯·杰斐逊大学医院接受治疗的127例患者中，3例需要再次手术（2.4%），10例因复发性或持续性甲状旁腺功能亢进前来就诊。手术失败的原因包括8例（62%）遗漏腺体、2例（15%）异位腺体、2例（15%）额外腺体以及1例（8%）自体移植发生恶性变。1例患者出现短期甲状旁腺功能减退，需要补充维生素D（5.6%），但未发生喉返神经损伤。我们得出结论，充分了解正常和异位腺体的位置并进行细致探查将减少大多数再次手术的发生，并且，通过识别所有四个腺体并对多腺体疾病患者常规行颈部胸腺切除术，再次手术率应低于5%。需要再次手术的患者应接受非侵入性定位检查，若结果不明确，则应进行甲状旁腺激素选择性静脉采血检查。主要并发症发生率应低于10%。
