Reoperation for parathyroid adenoma: A contemporary experience

被引：41

作者：

Powell, Anathea C. ^{[1
]}

Alexander, H. Richard ^{[1
]}

Chang, Richard ^{[2
]}

Marx, Stephen J. ^{[3
]}

Skarulis, Monica ^{[3
]}

Pingpank, James F. ^{[1
]}

Bartlett, David L. ^{[1
]}

Hughes, Marybeth ^{[1
]}

Weinstein, Lee S. ^{[3
]}

Simonds, William F. ^{[3
]}

Collins, Michael F. ^{[4
]}

Shawker, Thomas ^{[2
]}

Chen, Clara C. ^{[2
]}

Reynolds, James ^{[2
]}

Cochran, Craig ^{[3
]}

Steinberg, Seth M. ^{[5
]}

Libutti, Steven K. ^{[1
]}

机构：

[1] NCI, Tumor Angiogenesis Sect, Surg Branch, Bethesda, MD 20892 USA

[2] Warren F Magnuson Clin Ctr, Dept Diagnost Radiol, Bethesda, MD USA

[3] NIDDK, Metab Dis Branch, Bethesda, MD USA

[4] NIDCR, Skeletal Clin Studies Unit, Bethesda, MD USA

[5] NCI, Biostat & Data Management Sect, Off Clin Director, Ctr Canc Res,NIH, Bethesda, MD 20892 USA

来源：

SURGERY | 2009年 / 146卷 / 06期

关键词：

PRIMARY HYPERPARATHYROIDISM; RECURRENT HYPERPARATHYROIDISM; PREOPERATIVE LOCALIZATION; PERSISTENT; SURGERY; STRATEGY;

D O I：

10.1016/j.surg.2009.09.015

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background. We reviewed reoperations for persistent or recurrent sporadic parathyroid adenoma to evaluate and compare our current results and outcomes to our previous experience. Methods. From 1996 to 2008, 237 patients with persistent or recurrent hyperparathyroidism after failed operation underwent reoperation. Patients were re-explored with the assistance of non-invasive and sometimes invasive imaging. Results. A missed adenoma was suspected pre-operatively in 163 patients. Reoperation resulted in long-term resolution of hypercalcemia in 92%. Adenomas were in entopic locations in 32 %; the most frequent ectopic location was the thymus (20 %). Sestamibi scanning and ultrasonography were the most successful non-invasive imaging studies (96% positive predictive value (PPV) and 84% PPV respectively). Forty-four percent of patients had a reoperation based solely on non-invasive imaging. Of the invasive procedures performed, arteriography resulted in the best localization (92 % PPV). Permanent recurrent laryngeal nee injury occurred in 1.8%. Conclusion. Compared to our prior experience (1982-1995), outcomes remained similar (92 % resolution of hypercalcemia and 1.8% recurrent nerve injury currently versus 96 % and 1.3% previously). Fewer patients received invasive studies for pre-operative localization (56 % vs 73%, respectively). The decreased use of invasive imaging is due to technical improvements and greater confidence in the combination of ultrasonography and sestamibi scanning. (Surgery 2009; 146: 1144-55.)

引用

页码：1144 / 1155

页数：12

共 24 条

[1]

Agresti A., 1990, Categorical data analysis, P79

[2]

Alexander HR, 2002, J BONE MINER RES, V17, pN133

[3] 1112 consecutive bilateral neck explorations for primary hyperparathyroidism [J].

Allendorf, John ;

DiGorgi, Mary ;

Spanknebel, Kathryn ;

Inabnet, William ;

Chabot, John ;

LoGerfo, Paul .

WORLD JOURNAL OF SURGERY, 2007, 31 (11) :2075-2080

[4]

ARNOLD A, 2009, PRIMER METABOLIC BON

[5] Unilateral versus bilateral neck exploration for primary hyperparathyroidism - A prospective randomized controlled [J].

Bergenfelz, A ;

Lindblom, P ;

Tibblin, S ;

Westerdahl, J .

ANNALS OF SURGERY, 2002, 236 (05) :543-551

[6] RESULTS OF REOPERATION FOR PERSISTENT AND RECURRENT HYPERPARATHYROIDISM [J].

BRENNAN, MF ;

MARX, SJ ;

DOPPMAN, J ;

COSTA, J ;

SAXE, A ;

SPIEGEL, A ;

KRUDY, A ;

AURBACH, G .

ANNALS OF SURGERY, 1981, 194 (06) :671-676

[7] REOPERATION FOR PERSISTENT AND RECURRENT HYPERPARATHYROIDISM [J].

BRENNAN, MF ;

NORTON, JA .

ANNALS OF SURGERY, 1985, 201 (01) :40-44

[8]

BRUINING HA, 1987, SURGERY, V101, P562

[9]

CHEN CC, 1995, J NUCL MED, V36, P2186

[10]

CHEUNG PSY, 1989, ARCH SURG-CHICAGO, V124, P676

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