Indications for operative intervention in patients with asymptomatic primary hyperparathyroidism: Practice patterns of endocrine surgery
Indications for operative intervention in patients with asymptomatic primary hyperparathyroidism: Practice patterns of endocrine surgery
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DOI：
10.1016/j.surg.2005.09.006
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发表时间：
2006-04-01
期刊：
影响因子：
3.8
通讯作者：
Perrier, ND
中科院分区：
文献类型：
--
作者：
Kouvaraki, MA;Greer, M;Perrier, ND
背景资料。目前，许多原发性甲状旁腺功能亢进症(PHPT)患者被诊断为无症状时被诊断为甲状旁腺功能亢进症，这些患者是否需要接受甲状旁腺切除术一直受到质疑。美国国立卫生研究院(NIH)2002年无症状PHPT研讨会后起草的一份协商一致声明为此类患者的管理提供了指导方针，但被批评过于保守。本次调查的目的是确定这些指南对内分泌外科医生执业模式的影响。对美国内分泌外科医生协会(AAES)的成员进行了调查，以确定之前发表的无症状PHPT轮胎患者的处理共识指南是否用于决定是否进行甲状旁腺切除术，并确定哪些参数被认为是进行手术干预的指标。AAES成员被问及对无症状PHPT患者的管理、专业特征和人口统计学。在257名AAES成员中，96人(37%)回答了调查。尽管大多数受访者知道并遵循NIH会议的共识指南，但大多数(80%)外科医生会为不符合这些标准但有其他非特异性症状的PHPT患者进行手术。当术前定位研究呈阳性时，外科医生倾向于手术干预，即使没有达到NIH指南的标准。大多数愿意为所有PHPT患者进行手术的应答者，无论客观参数如何，都是拥有大量手术经验的外科医生(每年有30例甲状旁腺切除术)。多发性内分泌肿瘤(MEN)综合征的存在并没有改变对无症状患者进行手术的决定。内分泌外科医生不会仅仅根据客观标准来决定对PHPT患者进行手术干预。大多数经验丰富的大容量内分泌外科医生认为，主观主诉需要手术干预。
Background. Currently, many patients with primary hyperparathyroidism (PHPT) are diagnosed when they are considered to be "asymptomatic.", The need for parathyroidectomy in these patients has been questioned. A consensus statement drafted after the National Institutes of Health (NIH) 2002 Workshop on Asymptomatic PHPT provided guidelines for management of such patients but has been criticized for being too conservative. The purpose of this survey was to determine the impact of these guidelines on practice patterns of endocrine surgeons.Methods. Members of the American Association of Endocrine Surgeons (AAES) were surveyed to determine whether previously published consensus guidelines for management of asymptomatic patients with PHPT tire used to base the decision of whether to offer parathyroidectomy and to ascertain what parameters are considered indicators to proceed with operative intervention. AAES members were asked about the management of patients with asymptomatic PHPT, specialty characteristics, and demographics.Results. Of 257 AAES members, 96 (37 %) responded to the survey. Although the majority of the respondents were aware of and followed the NIH consensus conference guidelines, the majority of surgeons (80 %) would operate on a patient with PHPT who did not meet these criteria but had other nonspecific symptoms. Surgeons favored operative intervention when preoperative localization studies were positive, even if the criteria of the NIH guidelines were not fulfilled. Most of the responders who would operate on all patients with PHPT, regardless of objective parameters, were surgeons with a high-volume practice (> 30 parathyroidectomies per year). The presence of multiple endocrine neoplasia (MEN) syndromes did not alter the decision to operate on asymptomatic patients.Conclusions. Endocrine surgeons do not base the decision to intervene operatively in patients with PHPT solely on objective criteria. Most high-volume, experienced endocrine surgeons believe that subjective complaints warrant operative intervention.