Objective To investigate clinical features of accidental parathyroid adenoma (APTA) and to explore diagnosis and treatment strategies of APTA. Methods From February 2009 to December 2016, the patients who would receive the thyroid surgery and were accidentally found the parathyroid adenoma by preoperative examination in the Department of Thyroid & Parathyroid Surgery, West China Hospital of Sichuan University were enrolled in the research. The clinical characteristics, surgical procedure, results of postoperative follow-up were analyzed retrospectively, and which were compared between the patients with APTA and the other patients diagnosed as primary parathyroid adenoma or received thyroid surgery (1 : 4 chosen randomly) in the same period. Results From February 2009 to December 2016, the patients who treated with thyroid surgery and were diagnosed as the primary parathyroid adenoma in our center were 5 881 and 251 respectively. Twenty-six patients with APTA were found in this research. The incidence rate of APTA was 0.44% (26/5 881), accounted for 10.4% (26/251) of the primary parathyroid adenoma. The positive rates of the ultrasound and the parathyroid scintigraphy were 69.2% (18/26) and 72.7% (8/11), respectively. The abnormal rate of the bone mineral density examination was 85.7% (6/7). The preoperative PTH was (38.17±40.69) pmol/L (3.40–181.20 pmol/L), and the serum calcium was (2.73±0.27) mmol/L (2.22–3.23 mmol/L). The number of detected parathyroid adenoma was 29, which were 55.2% (16/29) in the right-lower, 6.9% (2/29) in the right-upper, 27.6% (8/29) in the left-lower, and 10.3% (3/29) in the left-upper location. The rate of single parathyroid adenoma was 88.5% (23/26) and the maximum diameter of parathyroid adenoma was (21.72±9.65) mm. There was 13 cases (44.8%) of the A1 type and 16 cases (55.2%) of the B1 type in these 29 parathyroid adenomas. The rates of the recurrence, postoperative transient hypoparathyroidism, and permanent hypoparathyroidism were 7.7% (2/26), 30.8% (8/26), and 3.8% (1/26), respectively. Additionally, the preoperative PTH and serum calcium levels of the patients with APTA were significantly lower as compared with the primary parathyroid adenoma (P<0.001,P<0.001), which were significantly higher as compared with those of the patients received thyroid surgery without APTA in the same period (P=0.001, P<0.001). Conclusions APTA is a specific type of asymptomatic primary hyperparathyroidism. Examinations for PTH and serum calcium levels before thyroid surgery are important for finding APTA. For the patients with APTA, it is safe and effective to carry out exploratory parathyroidectomy with thyroid surgery at the same time.
Giant thoracic tumor is currently one of the diagnostic and therapeutic challenges of thoracic surgery, with no established guideline or standard for diagnosis and treatment. The quality control of individualized surgical strategy and perioperative management with multi-disciplinary participation is the key to ensure the safety and improve the prognosis of patients. Based on the clinical experience of our institution and others, we hereby discussed and summarized the basic principles, surgical strategies and perioperative management of giant thoracic tumor, aiming to provide a reference of quality control.
Surgery is the only effective treatment for congenital choledochal cysts, as it allows for the resection of the cysts, the complete relief of cholangitis, and the prevention of canceration of cysts. The key elements of surgery for central choledochal cysts involve the cysts resection, bile-intestinal anastomosis, and biliopancreatic diversion. The difficulty in operating on central choledochal cysts lies in the rational decision making and effective management of cysts in the hilar and pancreatic regions. Depending on the type of central choledochal cysts with different anatomical patterns, a reasonable and feasible individualized surgical management strategy can be established to effectively avoid adverse therapeutic consequences such as postoperative biliary leakage, cholangio-intestinal anastomotic stricture, residual choledochal cysts and its carcinogenesis.
Objective To evaluate the application of surgical strategies for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) involving the C2 segment. Methods The literature about the surgery for cervical OPLL involving C2 segment was reviewed, and the indications, advantages, and disadvantages of surgery were summarized. Results For cervical OPLL involving the C2 segments, laminectomy is suitable for patients with OPLL involving multiple segments, often combined with screw fixation, and has the advantages of adequate decompression and restoration of cervical curvature, with the disadvantages of loss of cervical fixed segmental mobility. Canal-expansive laminoplasty is suitable for patients with positive K-line and has the advantages of simple operation and preservation of cervical segmental mobility, and the disadvantages include progression of ossification, axial symptoms, and fracture of the portal axis. Dome-like laminoplasty is suitable for patients without kyphosis/cervical instability and with negative R-line, and can reduce the occurrence of axial symptoms, with the disadvantage of limited decompression. The Shelter technique is suitable for patients with single/double segments and canal encroachment >50% and allows for direct decompression, but is technically demanding and involves risk of dural tear and nerve injury. Double-dome laminoplasty is suitable for patients without kyphosis/cervical instability. Its advantages are the reduction of damage to the cervical semispinal muscles and attachment points and maintenance of cervical curvature, but there is progress in postoperative ossification. Conclusion OPLL involving the C2 segment is a complex subtype of cervical OPLL, which is mainly treated through posterior surgery. However, the degree of spinal cord floatation is limited, and with the progress of ossification, the long-term effectiveness is poor. More research is needed to address the etiology of OPLL and to establish a systematic treatment strategy for cervical OPLL involving the C2 segment.