【Abstract】Objective To search for the significance of endoscopic thyroidectomy and parathyroidectomy. Methods Literatures about endoscopic thyroidectomy and parathyroidectomy were collected and reviewed. Results Thyroidectomy and parathyroidectomy may be performed with endoscope or with the help of endoscope. Conclusion By endoscopic thyroidectomy and parathyroidectomy, the patients are lightly injured without scar in the neck. The quality of life is improved.
Objective To summary the experience in diagnosis and managements for primary hyperparathyroidism（PHPT）. Methods The clinical data of 73 patients with PHPT who underwent parathyroidectomy in our hospital from Jan. 2003 to Dec. 2010 were analyzed retrospectively. Results There were 1 case of hyperplasia （1.4%）， 67 cases of adenoma （91.8%）， and 5 cases of adenocarcinoma （6.8%） among the 73 cases of PHPT. The common presentations involved with pain in bones and joints in 63 cases （86.3%）， pathologic fractures in 17 cases （23.3%）， osteoporosis in 59 cases （80.8%）， fatigue in 28 cases （38.4%）， abdominal pain in 4 cases （5.5%）， urolithiasis in 17 cases （23.3%）， malignant hypertension in 1 case （1.4%） who suffered multi-endocrine neoplasm （MEN）Ⅱa， and so on. The preoperativeserum parathyroid hormone （PTH） abnormally elevated in all 73 patients， and serum calcium abnormally elevated in 59 patients （80.8%）， and alkaline phosphatase abnormally elevated in 62 patients （84.9%） before operation. The positive rate of lesion locations by ultrasonography， CT， 99Tcm-sestamibi （MIBI） scan， and the combination of 3 kinds of tests were 82.8% （53/64）， 83.3% （20/24）， 90.2% （46/51）， and 91.8% （67/73） respectively， but 6 cases were not traced preop-eratively. Parathyroidectomy was conducted to all the cases， besides， regional neck lymphadenectomy was performed for those 5 adenocarcinoma cases. Tetany in 16 cases， hoarseness in 2 cases， acute pancreatitis in 1 case， acute left heart failure in 1 case were observed after operation. Sixty nine cases were follow-up for 3-72 months （average 17.3 months）. During the followed-up period， most of them were alleviated from bone pain （43 cases） and fatigue （18 cases）within 1 month. However， the recovery of PTH and serum calcium back to normality were relatively slow. One case ofadenoma recurred， 1 case of adenocarcinoma suffered lung metastasis， 1 case of adenocarcinoma survived for 37 monthsprior to death for postoperative lung and bone metastasis， the other cases （including 1 case of adenocarcinoma developed from adenoma） were still alive and had no metastasis or recurrence by the end of follow-up. Conclusions The symptoms of PHPT vary and lack of specificity， hence， the enhancement of knowledge to this disease and screenings conducted for parathyroid function and serum calcium will increase the rate of diagnosis. Parathyroidectomy is the effective management for PHPT， and preoperatively accurate position contribute to minimal exploration.
ObjectiveTo summarize the research status of normocalcemic parathormone elevation after parathyroidectomy for patients with primary hyperparathyroidism. MethodsThe related literatures on normocalcemic parathormone elevation after parathyroidectomy were collected and reviewed. ResultsMost of the patients with primary hyperparathyroidism received radical treatment postoperation. NPE didn't predict failure of operation. The relationship between normocalcemic parathormone elevation and recurrent primary hyperparathyroidism remained to be further explored. Patients with normocalcemic parathormone elevation after parathyroidectomy had a higher risk of cardiovascular disease. Postoperative vitamin D and calcium supplementation could reduce the incidence of normocalcemic parathormone elevation. ConclusionsThe clinical significance of normocalcemic parathormone elevation is still unknown at present. Further researches of multicenter, huge sample, and long-term follow-up will be necessary.
Objective To compare the clinical features and surgical effect between ectopic and orthotopic parathyroid lesions. Methods The clinical data of 136 patients with parathyroid lesions who had undergone parathyroidectomy between May 2010 and May 2017 were retrospectively analyzed. Results The ectopic parathyroid location was detected in 20 patients (14.7%) of the 136 patients with parathyroid lesions. Of the 20 patients, prevalence of superior mediastinal ectopic lesions accounted for 30.0% (6/20), prevalence of thyrothymic ligament accounted for 20.0% (4/20), prevalence of intrathymic accounted for 15.0% (3/20), prevalence of tracheoesophageal groove accounted for 25.0% (5/20), prevalence of submandibular accounted for 5.0% (1/20), prevalence of carotid sheath accounted for 5.0% (1/20), respectively. Patients with ectopic lesions had significantly higher level of serum parathyroid hormone (PTH) and alkaline phosphatase (AKP) than patients with orthotopic parathyroid lesions (P≤0.05). In addition, osteitis fibrosa cystica of metabolic bone disease was significantly more frequent in patients with ectopic parathyroid lesions than those with orthotopic parathyroid lesions (P=0.04). Preoperative ultrasonography had a sensitivity of 50.0% (10/20) for ectopic lesions and 90.1% (100/111) for orthotopic lesions. Preoperative 99Tcm methoxyisobutylisonitrile (99Tcm-MIBI) had a sensitivity of 100% (19/19）for ectopic lesions and 95.3% (101/106) for orthotopic lesions. Preoperative CT had a sensitivity of 81.3% (13/14) for ectopic lesions and 93.6% (102/109) for orthotopic lesions. Preoperative combination examination had a sensitivity of 100% (20/20) for ectopic lesions and 99.1% (108/109) for orthotopic lesions. Of the 20 patients with ectopic leisions, 17 patients (85.0%) had undergone 1 time of operation, 2 patients (10.0%) had undergone twice operations, 1 patient (5.0%) had undergone trice operations. The onset of hypocalcemia happened in 13 patients (65.0%) after operation. Of 116 patients with orthotopic leisions, only 1 patient had twice operations, the onset of hypocalcemia happened in 74 patients (63.8%) after operation. The reoperation rate of orthotopic leisions was lower than that of patients with ectopic leisions (P=0.01), but there was no significant difference on the incidence of hypocalcemia (P=0.92). Excessive bleeding and recurrent laryngeal nerve injury didn’t happen after all operations. Of 136 patients, 111 patients had followed-up, among which 17 patients with ectopic leisions and 94 patients with orthotopic leisions. During the followed-up period, there were no recurrence happened. Conclusions The ectopic parathyroid lesions are associated with higher serum PTH and AKP levels and more frequent metabolic bone disease in comparison with the orthotopic parathyroid lesions, as well as high reoperation rate. Combined examination, including cervical ultrasonography, 99Tcm-MIBI, and cervical enhanced CT are needed for preoperative location. Parathyroid lesions resection is the main surgical approach, and patients with parathyroid lesions are prone to be onset of hypocalcemia.
ObjectiveTo explore therapeutic efficacy of parathyroidectomy (PTX) in treatment of secondary hyperparathyroidism (SHPT) in patients with end-stage renal disease.MethodsThe clinical data of 50 patients who underwent PTX for uremic SHPT from January 2016 to March 2018 were collected retrospectively. The changes of serum calcium, phosphorus, and intact parathyroid hormone (iPTH) before the surgery and 1 d, 7 d, 1 month, 3 months and 12 months after the surgery were analyzed. In addition, the improvement of clinical symptoms together with the postoperative recurrence and complications were observed.ResultsTen patients underwent the subtotal PTX (SPTX), 5 cases underwent the total PTX (TPTX), and 35 cases underwent the TPTX with autotransplantation (TPTX+AT). The PTXs were performed successfully in 47/50 (94.0%) patients. After the PTX, the bone pain and skin itching were alleviated, 3 cases had the temporary injury of recurrent laryngeal nerve and the hypoparathyroidism was found in 1 case. The levels of postoperative serum iPTH, calcemia, and phosphorus were lower than those at the preoperative level, the differences were statistically significant (P<0.050). The postoperative hypocalcemia was frequently seen in 38/50 (76.0%) patients, and it was effectively controlled by the intravenous calcium. After the follow-up for 3 months, the SHPT recurred in 5 cases (10.0%), of whom 3 cases underwent the TPTX+AT. The relapse rate in 12 months after the operation was 9.1% (2/22). There were no statistical differences among the three PTXs methods in the operation successful rate (χ2=3.351, P=0.211) and relapse rates in 3 months (χ2=1.321, P=0.753) and 12 months (χ2=1.794, P=0.411) after the operation.ConclusionsIn China, TPTX+AT is more common than SPTX and TPTX in clinical application. Operations of SPTX, TPTX, and TPTX+AT are safe and effective therapeutic methods for uremic SHPT, which can significantly improve biochemical indicators and quality of life of patients.