Results of initial operation for hyperparathyroidism in patients with multiple endocrine neoplasia type 1
Results of initial operation for hyperparathyroidism in patients with multiple endocrine neoplasia type 1
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DOI：
10.1016/s0039-6060(03)00406-9
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发表时间：
2003-12-01
期刊：
影响因子：
3.8
通讯作者：
Alexander, HR
中科院分区：
文献类型：
--
作者：
Elaraj, DM;Skarulis, MC;Alexander, HR
背景。多发性内分泌瘤I型（MEN1）患者的甲状旁腺功能亢进以多腺体疾病和甲状旁腺切除术（PTx）后复发的倾向为特征。本研究分析了在一家机构接受初始PTx治疗的MEN1患者队列的结果。1960年4月至2002年9月间，92例MEN1患者接受了初始PTx治疗。结果根据甲状旁腺的切除程度进行分析。14%的人切除了2.5个或更少的腺体，69%的人切除了部分PTx， 17%的人切除了全部PTx（88%的人立即进行了自体移植）。初始手术治愈率为98%。排除6例失去随访的患者，33%的患者复发甲状旁腺功能亢进（小于或等于2.5 PTx后为46%，小计PTx后为33%，总PTx后为23%）。中位无复发生存期在小次PTx和总PTx之间没有统计学差异，但小次PTx和总PTx比小次PTx更长（分别为16.5年和7.0年，P = 0.03）。重度甲状旁腺功能低下的发生率为46%，而次全ptx组为26%。小计和总PTx结果。在men1相关甲状旁腺功能亢进的持久控制中，与较小的切除相比有更长的无复发间隔。全PTx术后严重甲状旁腺功能低下的高发生率表明，在这种情况下，小全PTx是首选的初始手术。
Background. Hyperparathyroidism in patients with multiple endocrine neoplasia type I (MEN1) is characterized by multiglandular disease and a Propensity for recurrence after Parathyroidectomy (PTx). This study analyzes outcomes of a cohort of MEN1 patients undergoing initial PTx at one institution.Methods. Between April 1960 and September 2002, 92 patients with MEN1 underwent initial PTx. Outcomes were analyzed based on extent of parathyroid resection.Results. Fourteen percent had 2.5 or fewer glands resected, 69% had subtotal PTx, and 17% had total PTx (88% with immediate autotransplantation). The initial surgical cure rate was 98%. Excluding 6 patients lost to follow-up, 33% have developed recurrent hyperparathyroidism (in 46% after less than or equal to 2.5 PTx, in 33% after subtotal, and in 23% after total PTx). Median recurrence free survival was not statistically significantly different between subtotal versus total PTx, but it was longer for subtotal and total PTx compared with lesser resection (16.5 vs 7.0 years, respectively, P = .03). The incidence of severe hypoparathyroidism was 46% after total versus 26% after subtotal PTx.Conclusions. Subtotal and total PTx result. in durable control of MEN1-associated hyperparathyroidism and have longer recurrence free intervals compared with lesser resection. The high incidence of severe hypoparathyroidism after total PTx suggests that subtotal PTx is the initial operation of choice in this setting.