Retrospective comparative analysis of unilateral neck exploration and direct minimally invasive parathyroidectomy in the treatment of primary hyperparathyroidism_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZENG Yanzhang , YU zhaoyan ,  YUAN Ping

Vascular and Thyroid Surgery Department of Guizhou Provincial People’s Hospital, Guiyang 550499, P. R. China;

Corresponding?author：

YUAN Ping, Email: yuanpinggzsy@163.com

Keywords：

primary hyperparathyroidism; intraoperative parathyroid hormone monitoring; surgical treatment

DOI：

10.7507/1007-9424.202308078

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To compare the clinical effects of unilateral neck exploration (UNE) and direct minimally invasive parathyroidectomy (DPT) in the treatment of primary hyperparathyroidism (PHPT). Methods The clinical datas of 87 PHPT patients treated with intraoperative parathyroid hormone monitoring (IPM) -assisted UNE and DMIP in Guizhou Provincial People’s Hospital between January 2016 and December 2021 were analyzed retrospectively. Results The average age of patients was (47.5±13.1) years, and there were 24 males (27.6%) and 63 females (72.4%). The pathological types of 87 cases were parathyroid adenoma in 78 cases (89.7%), atypical parathyroid adenoma in 5 cases (5.7%), parathyroid hyperplasia in 4 cases (4.6%), and no parathyroid carcinoma. Two cases (2.3%) developed recurrent laryngeal nerve injury, and 3 cases (3.4%) developed postoperative persistent hyperparathyroidism, of which 1 (1.1%) case underwent secondary surgery. There were no significant differences in the incidence of recurrent laryngeal nerve injury (2.0% vs. 2.6%, P=0.855) and postoperative persistent hyperparathyroidism between the UNE group and the DMIP group (2.0% vs. 5.3%, P=0.713). However, the intraoperative bleeding volume, operative time, hospitalization time, incision length, and pain score in the DMIP group were significantly less than or shorter than or lower than those in the UNE group (P<0.001). Conclusion There is no significant difference in the efficacy between the DMIP and UNE in the treatment of PHPT, but DMIP can significantly shorten the operative time and hospitalization time, and reduce the trauma.

Citation： ZENG Yanzhang, YU zhaoyan, YUAN Ping. Retrospective comparative analysis of unilateral neck exploration and direct minimally invasive parathyroidectomy in the treatment of primary hyperparathyroidism. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(12): 1478-1482. doi: 10.7507/1007-9424.202308078 Copy

1.	Yeh MW, Ituarte PH, Zhou HC, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab, 2013, 98(3): 1122-1129.
2.	王滟, 張勁松, 繆剛, 等. 原發性甲狀旁腺功能亢進的臨床特征分析. 中國全科醫學, 2018, 21(35): 4392-4396.
3.	周建平, 張浩, 董明. 原發性甲狀旁腺功能亢進癥手術方式的選擇. 中國普通外科雜志, 2008, 17(11): 1121-1123.
4.	Richards ML, Thompson GB, Farley DR, et al. An optimal algorithm for intraoperative parathyroid hormone monitoring. Arch Surg, 2011, 146(3): 280-285.
5.	姚曉愛, 昌紅, 姜濤, 等. 140例原發性甲狀旁腺功能亢進患者臨床資料分析. 中國腫瘤臨床, 2016, 43(23): 1035-1039.
6.	Walker MD, Silverberg SJ. Primary hyperparathyroidism. Nat Rev Endocrinol, 2018, 14(2): 115-125.
7.	崔銘, 王鷗, 廖泉. 原發性甲狀旁腺功能亢進癥診斷及手術治療進展. 協和醫學雜志, 2020, 11(4): 395-401.
8.	Romei C, Pardi E, Cetani F, et al. Genetic and clinical features of multiple endocrine neoplasia types 1 and 2. J Oncol, 2012, 2012: 705036.
9.	王鷗, 邢小平, 孟迅吾, 等. 無癥狀型原發性甲狀旁腺功能亢進癥臨床特點分析. 中華骨質疏松和骨礦鹽疾病雜志, 2010, 3(1): 18-22.
10.	Cetani F, Pardi E, Marcocci C. Parathyroid carcinoma. Front Horm Res, 2019, 51: 63-76.
11.	Christakis I, Bussaidy N, Clarke C, et al. Differentiating atypical parathyroid neoplasm from parathyroid cancer. Ann Surg Oncol, 2016, 23(9): 2889-2897.
12.	Kruijff S, Sidhu SB, Sywak MS, et al. Negative parafibromin staining predicts malignant behavior in atypical parathyroid adenomas. Ann Surg Oncol, 2014, 21(2): 426-433.
13.	田雨霖. 原發性甲狀旁腺功能亢進癥的診斷與外科治療. 中國實用外科雜志, 2008, 28(3): 221-223.
14.	Westerdahl J, Bergenfelz A. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: five-year follow-up of a randomized controlled trial. Ann Surg, 2007, 246(6): 976-980.
15.	Smit PC, Borel Rinkes IH, van Dalen A, et al. Direct, minimally invasive adenomectomy for primary hyperparathyroidism: An alternative to conventional neck exploration? Ann Surg, 2000, 231(4): 559-565.
16.	徐少明. 積極開展原發性甲狀旁腺功能亢進癥的微創外科治療. 中華醫學雜志, 2003, 83(11): 925-926.
17.	李朋, 韋偉. 原發性甲狀旁腺功能亢進診治的難點與進展. 臨床外科雜志, 2020, 28(3): 208-210.
18.	中華醫學會骨質疏松和骨礦鹽疾病分會, 中華醫學會內分泌分會代謝性骨病學組, 中華醫學會骨質疏松和骨礦鹽疾病分會, 等. 原發性甲狀旁腺功能亢進癥診療指南. 中華骨質疏松和骨礦鹽疾病雜志, 2014, 7(3): 187-198.
19.	胡亞, 廖泉, 牛哲禹, 等. 甲狀旁腺功能亢進合并分化型甲狀腺癌384例診治分析. 中國實用外科雜志, 2014, 34(4): 329-331.
20.	Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. JAMA Surg, 2016, 151(10): 959-968.
21.	Di Marco A, Mechera R, Glover A, et al. Focused parathyroidectomy without intraoperative parathyroid hormone measurement in primary hyperparathyroidism: Still a valid approach? Surgery, 2021, 170(5): 1383-1388.
22.	Calò PG, Pisano G, Tatti A, et al. Intraoperative parathyroid hormone assay during focused parathyroidectomy for primary hyperparathyroidism: is it really mandatory? Minerva Chir, 2012, 67(4): 337-342.
23.	Heller KS, Blumberg SN. Relation of final intraoperative parathyroid hormone level and outcome following parathyroidectomy. Arch Otolaryngol Head Neck Surg, 2009, 135(11): 1103-1107.
24.	廖泉, 胡亞, 趙玉沛. 小切口甲狀旁腺手術. 中華外科雜志, 2015, 53(3): 164-166.
25.	Najafian A, Kahan S, Olson MT, et al. Intraoperative PTH may not be necessary in the management of primary hyperparathyroidism even with only one positive or only indeterminate preoperative localization studies. World J Surg, 2017, 41(6): 1500-1505.
26.	黃盛, 劉曉芳, 謝飛來, 等. 術前立體定位在繼發性甲狀旁腺功能亢進癥手術中的應用. 中國普外基礎與臨床雜志, 2021, 28(2): 219-223.
27.	Witteveen JE, van Thiel S, Romijn JA, et al. Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature. Eur J Endocrinol, 2013, 168(3): R45-R53.
28.	朱信心, 魏濤, 龔日祥, 等. 136例原發性甲狀旁腺功能亢進的診治體會. 中國普外基礎與臨床雜志, 2014, 21(4): 452-457.

1. Yeh MW, Ituarte PH, Zhou HC, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab, 2013, 98(3): 1122-1129.
2. 王滟, 張勁松, 繆剛, 等. 原發性甲狀旁腺功能亢進的臨床特征分析. 中國全科醫學, 2018, 21(35): 4392-4396.
3. 周建平, 張浩, 董明. 原發性甲狀旁腺功能亢進癥手術方式的選擇. 中國普通外科雜志, 2008, 17(11): 1121-1123.
4. Richards ML, Thompson GB, Farley DR, et al. An optimal algorithm for intraoperative parathyroid hormone monitoring. Arch Surg, 2011, 146(3): 280-285.
5. 姚曉愛, 昌紅, 姜濤, 等. 140例原發性甲狀旁腺功能亢進患者臨床資料分析. 中國腫瘤臨床, 2016, 43(23): 1035-1039.
6. Walker MD, Silverberg SJ. Primary hyperparathyroidism. Nat Rev Endocrinol, 2018, 14(2): 115-125.
7. 崔銘, 王鷗, 廖泉. 原發性甲狀旁腺功能亢進癥診斷及手術治療進展. 協和醫學雜志, 2020, 11(4): 395-401.
8. Romei C, Pardi E, Cetani F, et al. Genetic and clinical features of multiple endocrine neoplasia types 1 and 2. J Oncol, 2012, 2012: 705036.
9. 王鷗, 邢小平, 孟迅吾, 等. 無癥狀型原發性甲狀旁腺功能亢進癥臨床特點分析. 中華骨質疏松和骨礦鹽疾病雜志, 2010, 3(1): 18-22.
10. Cetani F, Pardi E, Marcocci C. Parathyroid carcinoma. Front Horm Res, 2019, 51: 63-76.
11. Christakis I, Bussaidy N, Clarke C, et al. Differentiating atypical parathyroid neoplasm from parathyroid cancer. Ann Surg Oncol, 2016, 23(9): 2889-2897.
12. Kruijff S, Sidhu SB, Sywak MS, et al. Negative parafibromin staining predicts malignant behavior in atypical parathyroid adenomas. Ann Surg Oncol, 2014, 21(2): 426-433.
13. 田雨霖. 原發性甲狀旁腺功能亢進癥的診斷與外科治療. 中國實用外科雜志, 2008, 28(3): 221-223.
14. Westerdahl J, Bergenfelz A. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: five-year follow-up of a randomized controlled trial. Ann Surg, 2007, 246(6): 976-980.
15. Smit PC, Borel Rinkes IH, van Dalen A, et al. Direct, minimally invasive adenomectomy for primary hyperparathyroidism: An alternative to conventional neck exploration? Ann Surg, 2000, 231(4): 559-565.
16. 徐少明. 積極開展原發性甲狀旁腺功能亢進癥的微創外科治療. 中華醫學雜志, 2003, 83(11): 925-926.
17. 李朋, 韋偉. 原發性甲狀旁腺功能亢進診治的難點與進展. 臨床外科雜志, 2020, 28(3): 208-210.
18. 中華醫學會骨質疏松和骨礦鹽疾病分會, 中華醫學會內分泌分會代謝性骨病學組, 中華醫學會骨質疏松和骨礦鹽疾病分會, 等. 原發性甲狀旁腺功能亢進癥診療指南. 中華骨質疏松和骨礦鹽疾病雜志, 2014, 7(3): 187-198.
19. 胡亞, 廖泉, 牛哲禹, 等. 甲狀旁腺功能亢進合并分化型甲狀腺癌384例診治分析. 中國實用外科雜志, 2014, 34(4): 329-331.
20. Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. JAMA Surg, 2016, 151(10): 959-968.
21. Di Marco A, Mechera R, Glover A, et al. Focused parathyroidectomy without intraoperative parathyroid hormone measurement in primary hyperparathyroidism: Still a valid approach? Surgery, 2021, 170(5): 1383-1388.
22. Calò PG, Pisano G, Tatti A, et al. Intraoperative parathyroid hormone assay during focused parathyroidectomy for primary hyperparathyroidism: is it really mandatory? Minerva Chir, 2012, 67(4): 337-342.
23. Heller KS, Blumberg SN. Relation of final intraoperative parathyroid hormone level and outcome following parathyroidectomy. Arch Otolaryngol Head Neck Surg, 2009, 135(11): 1103-1107.
24. 廖泉, 胡亞, 趙玉沛. 小切口甲狀旁腺手術. 中華外科雜志, 2015, 53(3): 164-166.
25. Najafian A, Kahan S, Olson MT, et al. Intraoperative PTH may not be necessary in the management of primary hyperparathyroidism even with only one positive or only indeterminate preoperative localization studies. World J Surg, 2017, 41(6): 1500-1505.
26. 黃盛, 劉曉芳, 謝飛來, 等. 術前立體定位在繼發性甲狀旁腺功能亢進癥手術中的應用. 中國普外基礎與臨床雜志, 2021, 28(2): 219-223.
27. Witteveen JE, van Thiel S, Romijn JA, et al. Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature. Eur J Endocrinol, 2013, 168(3): R45-R53.
28. 朱信心, 魏濤, 龔日祥, 等. 136例原發性甲狀旁腺功能亢進的診治體會. 中國普外基礎與臨床雜志, 2014, 21(4): 452-457.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Retrospective comparative analysis of unilateral neck exploration and direct minimally invasive parathyroidectomy in the treatment of primary hyperparathyroidism

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