Direct, minimally invasive adenomectomy for primary hyperparathyroidism - An alternative to conventional neck exploration?

被引:68
作者
Smit, PG
Rinkes, IHMB
van Dalen, A
van Vroonhoven, TJMV
机构
[1] UMC Utrecht, Dept Surg, NL-3508 GA Utrecht, Netherlands
[2] UMC Utrecht, Dept Radiol, NL-3508 GA Utrecht, Netherlands
关键词
D O I
10.1097/00000658-200004000-00016
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective To evaluate the feasibility and efficacy of a direct, minimally invasive adenomectomy (MIA) as an alternative to conventional neck exploration (CNE) in patients with primary hyperparathyroidism. Summary Background Data Because primary hyperparathyroidism is caused by a solitary adenoma in 85% to 90% of patients, a direct adenomectomy through a mini-incision would theoretically suffice whenever an adenoma is correctly localized on preoperative imaging. If effective, a less invasive method could spare the patient an unnecessary bilateral neck exploration, thus saving time and rendering future surgical procedures in the neck less problematic. Methods Between October 1994 and October 1998, 110 consecutive patients with biochemically proven primary hyperparathyroidism who were to undergo surgery were enrolled in this study. Ultrasound and spiral CT were routinely performed as standard preoperative imaging modalities in the first series of 65 patients. In the second series of 45 patients, ultrasound was performed as the sole initial modality; it was supplemented by CT only in case of inconclusive test results. if test results were unequivocal tone adenoma), the patient was offered MIA. CNE was performed if the results were equivocal or if multiglandular disease was suspected. Results Overall, 84 patients were selected for MIA and 26 for CNE. In the first series, 2 MIA procedures (2/51) were converted to CNE because of negative perioperative findings, All 65 procedures resulted in normocalcemia. In the second series, all but five (4/33 MIAs, 1/12 CNEs) resulted in normocalcemia, A reexploration (CNE) was performed in three patients, resulting in normocalcemia after resection of a second or third adenoma, Two patients are still awaiting reexploration. In both series together, 78 of the 110 patients were successfully treated with MIA and spared CNE, Conclusion MIA is a safe and effective alternative to CNE that may replace CNE in approximately two thirds of all patients.
引用
收藏
页码:559 / 565
页数:7
相关论文
共 25 条
[1]  
Bergenfelz A, 1998, BRIT J SURG, V85, P1129
[2]   SINGLE AND MULTIGLAND DISEASE IN PRIMARY HYPERPARATHYROIDISM - CLINICAL FOLLOW-UP, HISTOPATHOLOGY, AND FLOW CYTOMETRIC DNA ANALYSIS [J].
BONJER, HJ ;
BRUINING, HA ;
BIRKENHAGER, JC ;
NISHIYAMA, RH ;
JONES, MA ;
BAGWELL, CB .
WORLD JOURNAL OF SURGERY, 1992, 16 (04) :737-744
[3]   2-methoxyisobutylisonitrile probe during parathyroid surgery: Tool or gadget? [J].
Bonjer, HJ ;
Bruining, HA ;
Pols, HAP ;
de Herder, WW ;
Proye, CAG ;
Carnaille, BML ;
Mohammedamin, RSA ;
Steyerberg, EW ;
Breeman, WAP ;
Krenning, EP .
WORLD JOURNAL OF SURGERY, 1998, 22 (06) :507-512
[4]   PARATHYROID ADENOMECTOMY UNDER LOCAL-ANESTHESIA WITH INTRAOPERATIVE MONITORING OF UCAMP AND OR 1-84 PTH [J].
CHAPUIS, Y ;
ICARD, P ;
FULLA, Y ;
NONNENMACHER, L ;
BONNICHON, P ;
LOUVEL, A ;
RICHARD, B .
WORLD JOURNAL OF SURGERY, 1992, 16 (04) :570-575
[5]   FURTHER EVIDENCE AGAINST THE ROUTINE USE OF PARATHYROID ULTRASONOGRAPHY PRIOR TO INITIAL NECK EXPLORATION FOR HYPERPARATHYROIDISM [J].
HASSELGREN, PO ;
FIDLER, JP .
AMERICAN JOURNAL OF SURGERY, 1992, 164 (04) :337-340
[6]   A NEW APPROACH TO PARATHYROIDECTOMY [J].
IRVIN, GL ;
PRUDHOMME, DL ;
DERISO, GT ;
SFAKIANAKIS, G ;
CHANDARLAPATY, SKC .
ANNALS OF SURGERY, 1994, 219 (05) :574-581
[7]   A NEW, PRACTICAL INTRAOPERATIVE PARATHYROID-HORMONE ASSAY [J].
IRVIN, GL ;
DERISO, GT .
AMERICAN JOURNAL OF SURGERY, 1994, 168 (05) :466-468
[8]  
JUHLIN C, 1989, AM J PATHOL, V135, P321
[9]   PRIMARY HYPERPARATHYROIDISM IN THE 1990S - CHOICE OF SURGICAL-PROCEDURES FOR THIS DISEASE [J].
KAPLAN, EL ;
YASHIRO, T ;
SALTI, G .
ANNALS OF SURGERY, 1992, 215 (04) :300-317
[10]   PROSPECTIVE COMPARISON OF RADIONUCLIDE, COMPUTED TOMOGRAPHIC, AND SONOGRAPHIC LOCALIZATION OF PARATHYROID TUMORS [J].
KRUBSACK, AJ ;
WILSON, SD ;
LAWSON, TL ;
COLLIER, BD ;
HELLMAN, RS ;
ISITMAN, AT .
WORLD JOURNAL OF SURGERY, 1986, 10 (04) :579-585