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首页> 外文期刊>ANZ journal of surgery >Pursuing the second ipsilateral gland during minimally invasive video‐assisted parathyroidectomy
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Pursuing the second ipsilateral gland during minimally invasive video‐assisted parathyroidectomy

机译：在微创视频辅助甲状旁腺切除术期间追求第二个Ipsilidallal腺体

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Background In patients with primary hyperparathyroidism ( PHPT ) and preoperative imaging suggesting a solitary parathyroid adenoma ( SPA ), focused parathyroidectomy is most often curative. Even so, large studies show up to 3% of patients experience persistent or recurrent PHPT . Unilateral neck exploration ( UNE ) aiming to identify the SPA and the other ipsilateral parathyroid may reduce this failure rate. We hypothesized that: (i) minimally invasive video‐assisted ( MIVA ) approach would facilitate UNE and (ii) this would be a clinically relevant strategy. Methods Prospective case series of a consecutive cohort of PHPT patients (with preoperative diagnosis of SPA ), who underwent MIVA‐UNE . A 15?mm collar incision and endoscopic magnification were utilized to both excise the SPA and seek the ipsilateral parathyroid gland. Results From 2009 to 2014, 132 patients were offered MIVA‐UNE (age: 63.0 (interquartile range: 11.2); females: 94 (71.2%); symptomatic: 89 (67.4%); mean serum corrected calcium: 2.7 (standard deviation: 0.9) mmol/L; mean serum parathyroid hormone: 16.8 (standard deviation: 11.8) pmol/L). Conversion from MIVA‐UNE to open UNE was required in 14 (10.6%) patients (excluded from subsequent analysis). MIVA‐UNE was concluded in 118 patients. The second ipsilateral parathyroid was identified in 62 (52.5%) patients and in 13 (11.0%) it appeared enlarged and was excised. Histopathology confirmed five (4.2%) of these glands to be hyperplastic. Conclusion MIVA‐UNE allows identification of the second ipsilateral parathyroid in about half the patients. This approach helped to diagnose and treat unexpected multigland disease in almost 5% of patients.
机译：患有原发性甲状旁腺功能亢进（PHPT）和术前成像患者的背景，表明孤立甲状旁腺腺瘤（SPA），聚焦的甲状旁腺切除术是最常治愈的。即便如此，大型研究显示出高达3％的患者体验持续或复发的PHPT。单侧颈部勘探（UNE）旨在识别SPA和其他IPsilAtalal甲状旁腺可降低这种失败率。我们假设：（i）微创视频辅助（MIVA）方法将有助于UNE和（ii）这将是一个临床相关的策略。方法潜在病例系列连续群体群体（术前诊断SPA），谁接受了Miva-Une。将15毫米的套环切口和内窥镜放大倍率用于切除水疗中心并寻求同侧甲状旁腺。结果2009年至2014年，提供了132名患者Miva-UNE（年龄：63.0（四分位数范围：11.2）;女性：94（71.2％）;症状：89（67.4％）;平均血清矫正钙：2.7（标准偏差： 0.9）mmol / l;平均血清甲状旁腺激素：16.8（标准差：11.8）pmol / l）。从Miva-UNE转换为开放UNE，在14名（10.6％）患者中需要（不包括从后续分析）。 Miva-Une在118​​名患者中得出结论。在62例（52.5％）患者中鉴定了第二个IpsilateLal甲状旁腺，并在13例（11.0％）中肿大并切除。组织病理学证实了这些腺体中的五（4.2％）过增薄。结论MiVA-UNE允许在大约一半患者中鉴定第二个Ipsilidal甲状旁腺。这种方法有助于诊断和治疗近5％的患者的意外的多岛病。

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