Chinese medical journal · 1997
Surgical treatment for primary hyperparathyroidism.
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Lo C Y, Kung A W, Lam K S
Аннотация
OBJECTIVE: To document the recent surgical results in the treatment of primary hyperparathyroidism (HPT) at Queen Mary Hospital.
METHODS: From 1995 to 1996, 30 patients underwent 31 operations for primary HPT. The data of 11 men and 19 women with ages ranging from 19 to 86 years (median: 57 years) were prospectively recorded with emphasis on the need of preoperative localization.
RESULTS: Symptoms of hypercalcemia were present in 20 (67%) and complications in 17 (57%) patients, respectively. Seventy-seven localization studies were performed in 28 patients (average: 2.6 tests/patient). Localization was accurate in 12 of 23 (52%) ultrasonographies, 11 of 26 (42%) CT scans and 16 of 27 (59%) scintigraphies. Twenty-six patients had a single adenoma excised while 3 patients with multiple endocrine neoplasia type I (MEN I) had subtotal parathyroidectomy for multiglandular hyperplasia during cervical exploration. Immediate normocalcemia was achieved in 29 patients. One patient had persistent hypercalcemia due to a supernumerary fifth gland in the superior mediastinum that was successfully excised in a second operation. One patient had a unilateral vocal cord paralysis and 4 patients needed calcium supplement on discharge. During a median follow-up of 5 months, all patients were normocalcemic with one requiring calcium supplements.
CONCLUSION: Surgical treatment for primary HPT is a safe procedure and is associated with a high success rate. In our experience routine preoperative localization study is not cost-effective.
METHODS: From 1995 to 1996, 30 patients underwent 31 operations for primary HPT. The data of 11 men and 19 women with ages ranging from 19 to 86 years (median: 57 years) were prospectively recorded with emphasis on the need of preoperative localization.
RESULTS: Symptoms of hypercalcemia were present in 20 (67%) and complications in 17 (57%) patients, respectively. Seventy-seven localization studies were performed in 28 patients (average: 2.6 tests/patient). Localization was accurate in 12 of 23 (52%) ultrasonographies, 11 of 26 (42%) CT scans and 16 of 27 (59%) scintigraphies. Twenty-six patients had a single adenoma excised while 3 patients with multiple endocrine neoplasia type I (MEN I) had subtotal parathyroidectomy for multiglandular hyperplasia during cervical exploration. Immediate normocalcemia was achieved in 29 patients. One patient had persistent hypercalcemia due to a supernumerary fifth gland in the superior mediastinum that was successfully excised in a second operation. One patient had a unilateral vocal cord paralysis and 4 patients needed calcium supplement on discharge. During a median follow-up of 5 months, all patients were normocalcemic with one requiring calcium supplements.
CONCLUSION: Surgical treatment for primary HPT is a safe procedure and is associated with a high success rate. In our experience routine preoperative localization study is not cost-effective.