Catania A, Sorrenti S, Di Matteo F M, Lippolis G, Falvo L, Spyrou M, Dibra A, De Antoni E
Istituto di III Clinica Chirurgica Generale e Terapia Chirurgica, Università degli Studi La Sapienza, Roma.
G Chir. 1997 Oct;18(10):497-501.
The Authors evaluated the results obtained in 145 patients operated on for hyperparathyroidism: 109 patients had primary hyperparathyroidism and 36 patients had secondary hyperparathyroidism. Preoperative localization by ultrasonography was assured in all cases, while only few patients were preoperatively evaluated by arteriography and selected venous sampling of the parathyroid hormone concentration. After surgical resection for primary hyperparathyroidism, transient postoperative hypoparathyroidism occurred in 30 patients (27.5%), recurrent disease occurred in 3 patients (2.7%), while 1 patient experienced persistent hypoparathyroidism (1%). In 3 patients (3%), resection of a solitary adenoma and biopsy of all parathyroid glands resulted in a permanent hypoparathyroidism which required long-term administration of vitamin D and oral calcium. Neither recurrent nor persistent hyperparathyroidism occurred in patients surgically treated for secondary hyperparathyroidism, and no postoperative hypoparathyroidism was registered. The Authors emphasize the importance of an adequate surgical strategy and accurate initial cervical exploration of the parathyroid glands as a necessary step for the correct treatment of this challenging disease.
作者评估了145例因甲状旁腺功能亢进接受手术治疗患者的结果:109例为原发性甲状旁腺功能亢进,36例为继发性甲状旁腺功能亢进。所有病例均通过超声进行术前定位,而只有少数患者术前接受了动脉造影和甲状旁腺激素浓度的选择性静脉采样评估。原发性甲状旁腺功能亢进手术切除后,30例患者(27.5%)出现术后短暂性甲状旁腺功能减退,3例患者(2.7%)出现疾病复发,1例患者出现持续性甲状旁腺功能减退(1%)。3例患者(3%)切除单个腺瘤并对所有甲状旁腺进行活检后出现永久性甲状旁腺功能减退,需要长期补充维生素D和口服钙剂。接受继发性甲状旁腺功能亢进手术治疗的患者未出现复发或持续性甲状旁腺功能亢进,也未记录到术后甲状旁腺功能减退。作者强调,对于这种具有挑战性的疾病,适当的手术策略和准确的初次颈部甲状旁腺探查作为正确治疗的必要步骤非常重要。