Naitoh T, Gagner M, Garcia-Ruiz A, Heniford B T
Department of General Surgery, /A-80 The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Surg Endosc. 1998 Mar;12(3):202-5; discussion 206. doi: 10.1007/s004649900634.
The fervor surrounding minimally invasive surgery, which began with laparoscopic cholecystectomy in the late 1980s, has spread to nearly all surgical specialties.
After experimental success in an animal model, we recently performed our first case of endoscopic subtotal parathyroidectomy in a 37-year-old man. The patient, who had a history of severe pancreatitis and pancreatic calculi, was diagnosed as having hyperparathyroidism. The option of endoscopic parathyroidectomy was proposed and accepted. After placing the first trocar directly under the platysma, a space was created by bluntly dissecting with the tip of a 5-mm endoscopic camera. Four parathyroid glands were identified, and after a frozen-section diagnosis of parathyroid hyperplasia, three-and-one-half of the glands were resected.
The patient developed slight hypercarbia and subcutaneous emphysema during the procedure, but no other problems were noted. His postoperative course was otherwise unremarkable.
This is the first case reported of an endoscopic parathyroidectomy. This experience makes us optimistic about the future of endoscopic neck surgery.
始于20世纪80年代末腹腔镜胆囊切除术的微创外科手术热潮，已蔓延至几乎所有外科专业领域。
在动物模型实验取得成功后，我们最近为一名37岁男性实施了首例内镜下甲状旁腺次全切除术。该患者有重症胰腺炎和胰腺结石病史，被诊断为甲状旁腺功能亢进。我们提出并得到患者接受了内镜下甲状旁腺切除术这一方案。在将第一个套管针直接置于颈阔肌下方后，用5毫米内镜摄像头的尖端钝性分离创建了一个空间。识别出四个甲状旁腺，经冰冻切片诊断为甲状旁腺增生后，切除了其中三个半甲状旁腺。
手术过程中患者出现轻度高碳酸血症和皮下气肿，但未发现其他问题。他的术后病程并无异常。
这是首例报道的内镜下甲状旁腺切除术病例。这一经验让我们对内镜颈部手术的未来充满乐观。
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