Background

Primary hyperparathyroidism is a common endocrine disorder with adenomas being the most frequent cause. The condition is conventionally treated by a bilateral neck exploration through a cervical incision with removal of the affected glands. Intra-operative parathyroid hormone (IOPTH) monitoring and pre-operative Tc99m MIBI scans are facilitating focused approaches like minimally invasive video-assisted parathyroidectomy (MiVAP) and totally endoscopic parathyroidectomy (TOEP).

Methods

Patients with primary hyperparathyroidism were tested for location of diseased gland and accordingly selected for endoscopic parathyroidectomy by either trans-vestibular or trans-axillary approach. Those having undergone prior neck surgery or irradiation and those with an enlarged thyroid were excluded. All patients underwent IOPTH measurement to confirm the completeness of diseased gland resection.

Results

Eleven cases meeting selection criteria underwent endoscopic trans-vestibular parathyroidectomy and 16 cases underwent endoscopic trans-axillary parathyroidectomy. The mean operative time and blood loss were 104 min and 34 mL in trans-vestibular approach, respectively, while they were 47 min and 68 mL for the trans-axillary approach. All patients had post-operative resolution of hypercalcaemia. A single conversion to cervical approach was performed due to unsatisfactory IOPTH fall. A single patient suffered transient recurrent laryngeal nerve palsy which resolved with steroids.

Conclusion

Endoscopic parathyroidectomy is a safe and feasible surgical procedure when combined with pre-operative imaging and intra-operative parathyroid hormone monitoring. There is a steady rise in the number of patients with primary hyperparathyroidism, a majority of whom have solitary gland affliction. Focused exploration is the current standard, wherein endoscopic surgery can be an important tool to improve outcomes.

中文翻译：

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内镜下甲状旁腺切除术：回顾性分析27例

背景

原发性甲状旁腺功能亢进是常见的内分泌疾病，腺瘤是最常见的原因。通常通过双侧颈部探查术来治疗该病，方法是通过宫颈切口切除患处的腺体。术中甲状旁腺激素（IOPTH）监测和术前Tc99m MIBI扫描正在促进聚焦方法，如微创电视辅助甲状旁腺切除术（MiVAP）和全内镜甲状旁腺切除术（TOEP）。

方法

对原发性甲状旁腺功能亢进症的患者进行了病变腺位置的检查，并因此选择了经膀胱或经腋入路的内镜下甲状旁腺切除术。排除那些曾经接受过颈部手术或放射线治疗的患者以及甲状腺肿大的患者。所有患者均接受IOPTH测量，以确认病变腺切除术的完整性。

结果

符合选择标准的11例行内镜下经腋下甲状旁腺切除术，另有16例行内镜下经腋下甲状旁腺切除术。经巩膜入路的平均手术时间和失血量分别为104分钟和34 mL，经腋窝入路的平均手术时间和失血量分别为47分钟和68 mL。所有患者术后血钙水平均升高。由于IOPTH下降不理想，单次转换为颈椎入路。一名患者遭受短暂性喉返神经麻痹，可通过类固醇消退。

结论

结合术前影像学检查和术中甲状旁腺激素监测，内镜下甲状旁腺切除术是一种安全可行的手术方法。原发性甲状旁腺功能亢进症患者的人数稳步上升，其中大多数患有孤立性腺病。聚焦探查是当前的标准，其中内窥镜手术可以成为改善预后的重要工具。