Klingler P J, Strolz S, Profanter C, Klingler A, Kendler D, Lhotta K, Bodner E, Riccabona G
Second Department of Surgery, University of Innsbruck, Austria.
World J Surg. 1998 Mar;22(3):301-7; discussion 307-8. doi: 10.1007/s002689900386.
In an endemic goiter area patients with hyperparathyroidism (HPTH) frequently also have thyroid abnormalities. In a retrospective study of 95 patients with HPTH we assessed the diagnostic accuracy of imaging techniques (ultrasonography or radionuclide scanning) for preoperative localization of parathyroid adenomas. Altogether 86% of our patients had goiter, requiring thyroid resections in 37%. For 19 patients the parathyroid exploration was the second or third cervical operation, most of them due to goiter. We found that the overall rate of transient and permanent recurrent nerve paralysis is considerably increased in patients with previous neck surgery (26% vs. 7%). The combination of ultrasonography and radionuclide scanning can lead surgeons to the site of parathyroid lesions responsible for HPTH in 85% of cases, although frequent nodular goiters can produce pitfalls for correct imaging in iodine-deficient countries. In endemic goiter areas preoperative localization studies can be recommended in patients with primary HPTH--for evaluation of thyroid pathology possibly leading to resection or its accuracy in localizing parathyroid adenomas. These studies also seem justified in patients with previously unsuccessful neck explorations for HPTH.
在地方性甲状腺肿流行地区，甲状旁腺功能亢进症（HPTH）患者常常还伴有甲状腺异常。在一项对95例HPTH患者的回顾性研究中，我们评估了成像技术（超声检查或放射性核素扫描）对甲状旁腺腺瘤术前定位的诊断准确性。我们的患者中共有86%患有甲状腺肿，其中37%需要进行甲状腺切除术。对于19例患者，甲状旁腺探查是第二次或第三次颈部手术，大多数是因为甲状腺肿。我们发现，既往有颈部手术史的患者，暂时性和永久性喉返神经麻痹的总体发生率显著增加（26%对7%）。超声检查和放射性核素扫描相结合，在85%的病例中可使外科医生找到导致HPTH的甲状旁腺病变部位，不过在缺碘国家，频繁出现的结节性甲状腺肿可能给正确成像带来困难。在地方性甲状腺肿流行地区，对于原发性HPTH患者，推荐进行术前定位研究——以评估可能导致甲状腺切除的甲状腺病变情况，或其对甲状旁腺腺瘤定位的准确性。对于既往HPTH颈部探查未成功的患者，这些研究似乎也有必要。
