Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen · 1999
[Early diagnosis and reoperation in persistent primary hyperparathyroidism].
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Walgenbach S, Junginger T
Аннотация
INTRODUCTION: The persistence rate of primary hyperparathyroidism after cervical exploration was estimated and early diagnosis and reoperation were evaluated in a prospective study.
METHODS: Between 1 August 1987 and 31 October 1998, 370 patients underwent surgery. The postoperative course is known in 94.6 % of these patients (follow-up 1 month-10 years, median 24 months).
RESULTS: Cervical exploration was successful in 97.5 % (n = 353) of the 361 patients with the first manifestation of primary hyperparathyroidism and in all patients with recurrence or persistence of the disease after initial operation elsewhere. In persistent primary hyperparathyroidism serum calcium levels remained elevated 4 days after surgery (n = 9, 2.5 %). Localization studies, preferably with (99m)Tc-MIBI-scintigraphy were attempted during the first postoperative week and could be performed in 4 patients. Four patients wished the procedure to be performed later.
CONCLUSION: Within one week after the initial intervention the diagnosis of persistent primary hyperparathyroidism can be established and localization studies as well as cervical reexploration can be carried out. An interval of 3 months from the initial operation to reexploration of the parathyroid area is recommended if the reexploration is impossible within one week. Mediastinal reoperations or surgical interventions in the neck sparing the perithyroid area may be carried out without consideration of specific intervals.
METHODS: Between 1 August 1987 and 31 October 1998, 370 patients underwent surgery. The postoperative course is known in 94.6 % of these patients (follow-up 1 month-10 years, median 24 months).
RESULTS: Cervical exploration was successful in 97.5 % (n = 353) of the 361 patients with the first manifestation of primary hyperparathyroidism and in all patients with recurrence or persistence of the disease after initial operation elsewhere. In persistent primary hyperparathyroidism serum calcium levels remained elevated 4 days after surgery (n = 9, 2.5 %). Localization studies, preferably with (99m)Tc-MIBI-scintigraphy were attempted during the first postoperative week and could be performed in 4 patients. Four patients wished the procedure to be performed later.
CONCLUSION: Within one week after the initial intervention the diagnosis of persistent primary hyperparathyroidism can be established and localization studies as well as cervical reexploration can be carried out. An interval of 3 months from the initial operation to reexploration of the parathyroid area is recommended if the reexploration is impossible within one week. Mediastinal reoperations or surgical interventions in the neck sparing the perithyroid area may be carried out without consideration of specific intervals.