Single Center Experience in the Surgical Management of Primary Hyperparathyroidism
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objectives. As calcium included as a part of routine laboratory screening early diagnosis of primary hyperparathyroidism (PHPT) has been increased. Surgical resection of parathyroid adenoma or hyperplasia still is the mainstay of the treatment for most PHPT patients. The aim of this study was to evaluate of the surgical outcomes of patients with PHPT that referred to our ENT department of our University Hospital for the last 6 years. Methods. One hundred thirty-seven patients with PHPT who underwent parathyroid surgery in our clinic between October 2011 and January 2018 included in this retrospective study. Data on demographics, clinical findings, past medical history, preoperative laboratory values in 3 months, preoperative localizing imaging studies including ultrasonography (USG) and 99mTc-sestamibi (methoxyisobutyl isonitrile, [MIBI]) scan, operative findings, postoperative laboratory values, and pathology reports were recorded. MIBI scan and USG are used as the first-line modalities in our center. Single-photon emission computed tomography was used for challenging situations of re-exploration and ectopic parathyroid pathology. Four-dimensional computed tomography scanning is was preferred as the last imaging modality. Focused unilateral neck exploration (FUNE) was performed with intraoperative frozen section analysis as a routine procedure. Bilateral neck exploration (BNE) was used only in re-exploration, ectopic parathyroid, and with high suspicion of multigland disease. Results. Totally 137 patients (female:male, 3:3; mean age, 54.6±13.2 years) included in the study. Single parathyroid adenoma was found in 108 patients (78.8%). Most common adenoma localization was left inferior parathyroid gland (46.7%). FUNE was performed in 89.8% of the patients and BNE for 10.2% of the patients. Postoperative normocalcemia was reached in 132 patients and permanent hypocalcemia was observed in two patients. Persistence hypercalcemia observed in three patients. Postoperative pathology reports revealed three patients have parathyroid carcinoma. Conclusion. Preoperative imaging modalities is very important in parathyroidectomy surgery. Routine use of preoperative imaging modalities reduced the risk of complications in our clinic.
Abstract
Objectives. As calcium included as a part of routine laboratory screening early diagnosis of primary hyperparathyroidism (PHPT) has been increased. Surgical resection of parathyroid adenoma or hyperplasia still is the mainstay of the treatment for most PHPT patients. The aim of this study was to evaluate of the surgical outcomes of patients with PHPT that referred to our ENT department of our University Hospital for the last 6 years. Methods. One hundred thirty-seven patients with PHPT who underwent parathyroid surgery in our clinic between October 2011 and January 2018 included in this retrospective study. Data on demographics, clinical findings, past medical history, preoperative laboratory values in 3 months, preoperative localizing imaging studies including ultrasonography (USG) and 99mTc-sestamibi (methoxyisobutyl isonitrile, [MIBI]) scan, operative findings, postoperative laboratory values, and pathology reports were recorded. MIBI scan and USG are used as the first-line modalities in our center. Single-photon emission computed tomography was used for challenging situations of re-exploration and ectopic parathyroid pathology. Four-dimensional computed tomography scanning is was preferred as the last imaging modality. Focused unilateral neck exploration (FUNE) was performed with intraoperative frozen section analysis as a routine procedure. Bilateral neck exploration (BNE) was used only in re-exploration, ectopic parathyroid, and with high suspicion of multigland disease. Results. Totally 137 patients (female:male, 3:3; mean age, 54.6±13.2 years) included in the study. Single parathyroid adenoma was found in 108 patients (78.8%). Most common adenoma localization was left inferior parathyroid gland (46.7%). FUNE was performed in 89.8% of the patients and BNE for 10.2% of the patients. Postoperative normocalcemia was reached in 132 patients and permanent hypocalcemia was observed in two patients. Persistence hypercalcemia observed in three patients. Postoperative pathology reports revealed three patients have parathyroid carcinoma. Conclusion. Preoperative imaging modalities is very important in parathyroidectomy surgery. Routine use of preoperative imaging modalities reduced the risk of complications in our clinic.
참고문헌 (16)
- Binnetoglu A, "A surgical challange for primary hyperparathyroidism : intravagal parathyroid adenoma", Arch Otolaryngol Rhinol, 4(3), pp.057~060 (2018)
- Bilezikian JP, "Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop", J Clin Endocrinol Metab, 94(2), pp.335~339 (2009)
- Clark OH, "How should patients with primary hyperparathyroidism be treated?", J Clin Endocrinol Metab, 88(7), pp.3011~3014 (2003)
- Morris LF, "Fewer adverse events after reoperative parathyroidectomy associated with initial minimally invasive parathyroidectomy", Am J Surg, 208(5), pp.850~855 (2014)
- Sosa JA, "Minimally invasive parathyroidectomy", Surg Oncol, 12(2), pp.125~134 (2003)
- Udelsman R, "The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism", Ann Surg, 253(3), pp.585~591 (2011)
- Coffey RJ, "The surgical treatment of primary hyperparathyroidism : a 20 year experience", Ann Surg, 185(5), pp.518~523 (1977)
- Wilhelm SM, "The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism", JAMA Surg, 151(10), pp.959~968 (2016)
- Gasparri G, "Updates in primary hyperparathyroidism", Updates Surg, 69(2), pp.217~223 (2017)
- Norman J, "Abandoning unilateral parathyroidectomy : why we reversed our position after 15, 000 parathyroid operations", J Am Coll Surg, 214(3), pp.260~269 (2012)
- Horanyi J, "Parathyroid surgical failures with misleading falls of intraoperative parathyroid hormone levels", J Endocrinol Invest, 26(11), pp.1095~1099 (2003)
- Kuzminski SJ, "Update in parathyroid imaging", Magn Reson Imaging Clin N Am, 26(1), pp.151~166 (2018)
- Mortenson MM, "Parathyroid exploration in the reoperative neck : improved preoperative localization with 4D-computed tomography", J Am Coll Surg, 206(5), pp.888~895 (2008)
- Kelly HR, "4D-CT for preoperative localization of abnormal parathyroid glands in patients with hyperparathyroidism : accuracy and ability to stratify patients by unilateral versus bilateral disease in surgery-naive and re-exploration patients", AJNR Am J Neuroradiol, 35(1), pp.176~181 (2014)
- Bilezikian JP, "Clinical practice : asymptomatic primary hyperparathyroidism", N Engl J Med, 350(17), pp.1746~1751 (2004)
- Afzal A, "Management of hyperparathyroidism : a five year surgical experience", J Pak Med Assoc, 61(12), pp.1194~1198 (2011)