Defechereux T, Faymonville M E, Joris J, Hamoir E, Moscato A, Meurisse M
Service de Chirurgie des Glandes Endocrines et de Transplantation, Centre Hospitalier Universitaire, Domaine Universitaire due Sart-Tilman, Liêge, Belgique.
Ann Chir. 1998;52(5):439-43.
The elective unilateral approach, sometimes under local anaesthesia, offers many advantages in terms of less invasive and faster surgical approach compared to the conventional surgery under general anaesthesia. Nevertheless this approach is restricted to patients unsuspected of multiglandular disease, free from thyroid disease and for whom localization studies are contributive. Surgery under hypnosedation offers the same advantages and provides the possibility of not only exploring the four glands but also of performing a partial thyroidectomy if needed. In our experience 21 patients underwent a cervicotomy under hypnosedation for primary hyperparathyroidism (HPT). No conversion to general anaesthesia was needed; mean operative time was 52 +/- 16 min. In 17 cases, HPT was due to a single adenoma, in 3 cases to hyperplasia (among them a MEN-1 case), and in one last case to a double adenoma. The four glands were identified in 85%. With a follow-up running from 4 to 45 months, all patients are cured. Hypnosedation offers the same medical and economic advantages than the unilateral access under local anaesthesia. Moreover indications are not restricted to selected patients.
选择性单侧入路，有时在局部麻醉下进行，与全身麻醉下的传统手术相比，在侵入性较小和手术方法更快方面具有许多优势。然而，这种方法仅限于未怀疑有多腺疾病、无甲状腺疾病且定位研究有帮助的患者。催眠镇静下的手术具有相同的优势，不仅可以探查四个腺体，还可以在需要时进行部分甲状腺切除术。根据我们的经验，21例患者在催眠镇静下接受了颈切开术治疗原发性甲状旁腺功能亢进症（HPT）。无需转为全身麻醉；平均手术时间为52 +/- 16分钟。17例中，HPT是由单个腺瘤引起的，3例是由增生引起的（其中1例是MEN-1病例），最后1例是由双腺瘤引起的。85%的患者四个腺体均被识别。随访时间为4至45个月，所有患者均治愈。催眠镇静与局部麻醉下的单侧入路相比，具有相同的医学和经济优势。此外，适应症不限于特定患者。
