中国普外基础与临床杂志

中国普外基础与临床杂志

原发性甲状旁腺功能亢进症再次手术分析(附 11 例报道)

查看全文

目的 分析原发性甲状旁腺功能亢进症患者再次手术的原因及相关临床特点。 方法 回顾性分析笔者所在医院 1993 年 1 月至 2017 年 5 月期间行手术治疗的原发性甲状旁腺功能亢进症患者中再次行手术治疗者的临床资料。 结果 共收集到 226 例行手术治疗的原发性甲状旁腺功能亢进症患者中再手术患者 11 例,再次手术率为 5%(11/226)。其中行 2 次手术者 8 例, 3 次手术者 2 例, 5 次手术者 1 例。初次手术后病情持续 3 例,复发 7 例,有 1 例未定义为病情持续或复发。再次手术前患者的主要临床表现为乏力及肢体关节疼痛。再次手术的原因:异位甲状旁腺 3 例,甲状旁腺腺癌复发 3 例,甲状旁腺癌扩大切除 1 例,甲状旁腺双腺瘤新发 2 例,甲状旁腺遗漏 1 例,甲状旁腺增生 1 例。术前定位检查中行 99m-甲氧基异丁基异腈甲状旁腺双时相扫描的敏感度最高(8/9)。8 例选原颈部切口,3 例异位甲状旁腺病变选新切口。随访时间 4~70 个月(平均 23 个月),术后 2 例失访,1 例死亡,余 8 例患者随访期间均无复发。 结论 术前综合运用影像学检查精准定位病变、由经验丰富的术者操作及熟知甲状旁腺解剖学和胚胎学,能降低甲状旁腺功能亢进症的再手术率及提高再手术成功率。

Objective To analysis causes of reoperation for primary hyperparathyroidism and its clinical characteristics. Method The clinical data of the patients with primary hyperparathyroidism who had undergone reoperation from January 1993 to May 2017 were retrospectively analyzed. Results A total of 11 patients underwent reoperation were collected in the 226 patients with primary hyperparathyroidism. Of the 11 cases, 8 cases underwent twice operations, 2 cases underwent thrice operations, 1 case underwent quintic operation. After the initial operation, 3 cases were persistent diseases and 7 cases were recurrent diseases, 1 patient was not defined as the persistent or recurrent disease. The main clinical manifestations before the reoperation were fatigue, pain in joints, bones, or muscle. The reasons for reoperation included 3 cases of ectopic parathyroid lesions, 3 cases of recurrent parathyroid carcinomas, 1 case of enlarged operation extent for parathyroid carcinoma, 2 cases of regrowth of double parathyroid aedomas, 1 case of missing adenoma, 1 case of parathyroid hyperplasia. Among the location examinations, the 99Tcm-MIBI was most sensitivity (8/9). Eight cases were received reoperation on the original incision, and the remaining 3 ectopic parathyroid lesions on the new incision. After the reoperation, 2 patients were lost of follow-up, 1 patient died, and the remaining 8 patients had no recurrences during follow-up period. Conclusion A comprehensive approach with multiple imageology examinations which attribute to accurate location of lesions, experienced surgeons and well knowledge of parathyroid anatomy and embryology help to descend reoperation ratio and improve success rate of reoperation.

关键词: 原发性甲状旁腺功能亢进症; 甲状旁腺激素; 99m-甲氧基异丁基异腈; 再手术

Key words: primary hyperparathyroidism; parathyroid hormone; 99Tcm-MIBI; reoperation

引用本文: 胡琳, 崔爱民, 柏楠, 张自琴, 宋磊, 张强, 王彦彬. 原发性甲状旁腺功能亢进症再次手术分析(附 11 例报道). 中国普外基础与临床杂志, 2018, 25(2): 178-183. doi: 10.7507/1007-9424.201707112 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg, 2002, 235(5): 665-672.
2. Vojvodich SM, Lampe HB. Imaging and surgery in hyperparathyroidism: a 10-year review. J Otolaryngol, 1996, 25(2): 126-129.
3. Gaz RD, Doubler PB, Wang CA. The management of 50 unusual hyperfunctioning parathyroid glands. Surgery, 1987, 102(6): 949-957.
4. Mariette C, Pellissier L, Combemale F, et al. Reoperation for persistent or recurrent primary hyperparathyroidism. Langenbecks Arch Surg, 1998, 383(2): 174-179.
5. Albuja-Cruz MB, Allan BJ, Parikh PP, et al. Efficacy of localization studies and intraoperative parathormone monitoring in the surgical management of hyperfunctioning ectopic parathyroid glands. Surgery, 2013, 154(3): 453-460.
6. Granberg PO, Johansson G, Lindvall N, et al. Reoperation for primary hyperparathyroidism. Am J Surg, 1982, 143(3): 296-300
7. Brennan MF, Marx SJ, Doppman J, et al. Results of reoperation for persistent and recurrent hyperparathyroidism. Ann Surg, 1981, 194(6): 671-676.
8. al-Fehaily M, Clark OH. Persistent or recurrent primary hyperparathyroidism. Ann Ital Chir, 2003, 74(4): 423-434.
9. Tezelman S, Shen W, Siperstein AE, et al. Persistent or recurrent hyperparathyroidism in patients with double adenomas. Surgery, 1995, 118(6): 1115-1124.
10. 朱预. 原发性甲状旁腺功能亢进症治疗中的几个问题. 临床外科杂志, 2000, 8(4): 238-240.
11. Gray SW, Skandalakis JE, Akin JT Jr. Embryological considerations of thyroid surgery: developmental anatomy of the thyroid, parathyroids and the recurrent laryngeal nerve. Am Surg, 1976, 42(9): 621-628.
12. Phitayakorn R, McHenry CR. Incidence and location of ectopic abnormal parathyroid glands. Am J Surg, 2006, 191(3): 418-423.
13. Shen W, Düren M, Morita E, et al. Reoperation for persistent or recurrent primary hyperparathyroidism. Arch Surg, 1996, 131(8): 861-869.
14. Scharpf J, Kyriazidis N, Kamani D, et al. Anatomy and embryology of the parathyroid gland. Oper Techn Otolaryngol-Head Neck Surg, 2016, 27(3): 117-121.
15. Roy M, Mazeh H, Chen H, et al. Incidence and localization of ectopic parathyroid adenomas in previously unexplored patients. World J Surg, 2013, 37(1): 102-106.
16. Mendoza V, Ramírez C, Espinoza AE, et al. Characteristics of ectopic parathyroid glands in 145 cases of primary hyperparathyroidism. Endocr Pract, 2010, 16(6): 977-981.
17. Haciyanli M, Lal G, Morita E, et al. Accuracy of preoperative localization studies and intraoperative parathyroid hormone assay in patients with primary hyperparathyroidism and double adenoma. J Am Coll Surg, 2003, 197(5): 739-746.
18. Caron NR, Sturgeon C, Clark OH. Persistent and recurrent hyperparathyroidism. Curr Treat Options Oncol, 2004, 5(4): 335-345.
19. Kebebew E, Arici C, Duh QY, et al. Localization and reoperation results for persistent and recurrent parathyroid carcinoma. Arch Surg, 2001, 136(8): 878-885.
20. Mundschenk J, Klose S, Lorenz K, D et al. Diagnostic strategies and surgical procedures in persistent or recurrent primary hyperparathyroidism. Exp Clin Endocrinol Diabetes, 1999, 107(6): 331-336.
21. Rodriquez JM, Tezelman S, Siperstein AE, et al. Localization procedures in patients with persistent or recurrent hyperparathyroidism. Arch Surg, 1994, 129(8): 870-875.
22. Koslin DB, Adams J, Andersen P, et al. Preoperative evaluation of patients with primary hyperparathyroidism: role of high-resolution ultrasound. Laryngoscope, 1997, 107(9): 1249-1253.
23. Grant CS, Thompson G, Farley D, et al. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo clinic experience. Arch Surg, 2005, 140(5): 472-478.