Cervical exploration for primary hyperparathyroidism
Cervical exploration for primary hyperparathyroidism
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原发性甲状旁腺功能亢进症的宫颈探查
DOI：
10.1002/jso.2930520105
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发表时间：
1993
影响因子：
2.5
通讯作者：
B. Jaffe
中科院分区：
文献类型：
--
作者：
A. Shaha;B. Jaffe
原发性甲状旁腺功能亢进的经典表现，“呻吟，骨骼，呻吟”，不再常见，因为高钙血症的诊断现在可以更早地与SMA 12的常规使用。在过去的8年半中，85例原发性甲状旁腺功能亢进症患者在我们的机构进行了颈部探查。患者包括34名男性和51名女性，年龄从18岁到84岁不等。具体症状包括40例患者的高血压、25例患者的全身无力、14例患者的肾结石、2例患者的精神问题和4例患者的X线骨变化。41例患者完全无症状。诊断主要基于病史、血清钙和磷水平、甲状旁腺激素测定和24小时尿钙研究。对38例患者进行了术前定位研究。铊锝减影扫描，当阳性时，是非常有帮助的。手术方法包括逐步探查颈部两侧，识别所有四个甲状旁腺。在单腺体病变的患者中（87%），腺瘤至少切除一个正常腺体活检。在多腺体疾病中，切除异常腺体。常规进行冷冻切片以确认甲状旁腺组织的存在，未尝试在病理学上区分腺瘤和增生。2例患者患有甲状旁腺癌。在3名患者中，血清钙水平没有下降，导致手术成功率为96%。1例接受甲状旁腺次全切除术的患者发生永久性甲状旁腺功能减退，另1例发生暂时性低钙血症。只有一个病人发展成声带麻痹。原发性甲状旁腺功能亢进患者应早期探查。基本的诊断检查足以进行初步探查。在仔细的双侧探查和识别所有四个甲状旁腺后，区分单腺体和多腺体病变是很重要的。© 1993 Wiley利斯公司
The classical presentation of primary hyperparathyroidism, “moans, bones, groans,” is no longer commonly seen since the diagnosis of hypercalcemia is now made much earlier with the routine use of the SMA 12. In the past 8 1/2 years, 85 patients underwent cervical exploration in our institution for primary hyperparathyroidism. There were 34 male and 51 female patients, ranging in age from 18–84 years. The specific symptoms included hypertension in 40 patients, generalized weakness in 25, renal stones in 14, psychiatric problems in 2, and bone changes on X‐ray in 4. Forty‐one patients were totally asymptomatic. The diagnosis was made mainly on the basis of history, serum calcium and phosphorous levels, parathormone assay, and 24‐hour urinary calcium studies. Preoperative localization studies were performed in 38 patients. Thallium technetium subtraction scans, when positive, were very helpful. The surgical approach involved stepwise exploration of both sides of the neck with identification of all four parathyroid glands. In patients with uniglandular pathology (87%), the adenoma was removed with biopsy of at least one normal gland. In multiglandular disease, the abnormal glands were removed. Frozen section was routinely performed to confirm the presence of parathyroid tissue and no attempt was made to pathologically distinguish adenoma from hyperplasia. Two patients had parathyroid carcinoma. In three patients, serum calcium levels did not fall, resulting in an operative success rate of 96%. One patient treated by subtotal parathyroidectomy developed permanent hypoparathyroidism and one other patient developed temporary hypocalcemia. Only a single patient developed vocal cord palsy. Early exploration in patients with primary hyperparathyroidism is indicated. The basic diagnostic workup is sufficient for initial exploration. It is important to distinguish uniglandular from multiglandular pathology after careful bilateral exploration and identification of all four parathyroid glands. © 1993 Wiley‐Liss, Inc.