Nederlands tijdschrift voor geneeskunde · 2002
[Surgical treatment of primary hyperparathyroidism: minimally invasive if possible, conventional neck exploration if necessary].
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van Vroonhoven Th J M V
Аннотация
OBJECTIVE: To determine the results of surgical treatment of patients with primary hyperparathyroidism by means of a protocol consisting of preoperative imaging, perioperative parathormone (PTH) measurement, and a minimally invasive approach in the case of a solitary parathyroid adenoma being unequivocally identified and a conventional neck exploration in all other cases.
DESIGN: Prospective and descriptive.
METHODS: A total of 100 consecutive patients with primary hyperparathyroidism underwent neck imaging (ultrasound, CT) according to a fixed protocol. When a solitary parathyroid adenoma could be unequivocally identified, patients underwent minimal invasive surgery. All other patients underwent a conventional systematic neck exploration. If during the minimally invasive approach the parathyroid adenoma could not be found or the PTH level did not exhibit a decrease of more than 50% perioperatively, the procedure was converted to a conventional neck exploration. A successful operation was defined as a persistent normocalcaemia.
RESULTS: In 74 patients preoperative imaging was performed with ultrasound and CT, in 20 patients only ultrasound was used, 4 patients underwent CT in combination with scintigraphy and 2 patients only CT. In 72 of the 100 patients a minimally invasive approach was carried out and for 6 of these the procedure was converted to a conventional neck exploration (in 4 patients the adenoma was not found, in 2 there was an insufficient decrease in PTH level). A primary conventional exploration was carried out in 28 patients. Normocalcaemia was achieved in 98 of the 100 patients. In 2 patients the hypercalcaemic state persisted (in one due to iatrogenic failure, in one due to a mediastinal adenoma).
CONCLUSION: The protocol presented had a 98% success rate. Therefore, a conventional neck exploration is no longer the procedure of first choice in the surgical treatment of primary hyperparathyroidism; in two thirds of cases a minimally invasive technique suffices.
DESIGN: Prospective and descriptive.
METHODS: A total of 100 consecutive patients with primary hyperparathyroidism underwent neck imaging (ultrasound, CT) according to a fixed protocol. When a solitary parathyroid adenoma could be unequivocally identified, patients underwent minimal invasive surgery. All other patients underwent a conventional systematic neck exploration. If during the minimally invasive approach the parathyroid adenoma could not be found or the PTH level did not exhibit a decrease of more than 50% perioperatively, the procedure was converted to a conventional neck exploration. A successful operation was defined as a persistent normocalcaemia.
RESULTS: In 74 patients preoperative imaging was performed with ultrasound and CT, in 20 patients only ultrasound was used, 4 patients underwent CT in combination with scintigraphy and 2 patients only CT. In 72 of the 100 patients a minimally invasive approach was carried out and for 6 of these the procedure was converted to a conventional neck exploration (in 4 patients the adenoma was not found, in 2 there was an insufficient decrease in PTH level). A primary conventional exploration was carried out in 28 patients. Normocalcaemia was achieved in 98 of the 100 patients. In 2 patients the hypercalcaemic state persisted (in one due to iatrogenic failure, in one due to a mediastinal adenoma).
CONCLUSION: The protocol presented had a 98% success rate. Therefore, a conventional neck exploration is no longer the procedure of first choice in the surgical treatment of primary hyperparathyroidism; in two thirds of cases a minimally invasive technique suffices.