A novel surgical strategy for secondary hyperparathyroidism: Purge parathyroidectomy
| Autor: | Ming Qiu, Qiang Wang, Nian-Cun Qiu, Chun-Yan Xia, Pei-Pei Zhu, Zhi-Peng Du, Cheng-Xiang Shan, Miao-E Liu, Zha Siluo, Wei Zhang |
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| Rok vydání: | 2017 |
| Předmět: |
Parathyroidectomy
Adult Male medicine.medical_specialty medicine.medical_treatment 030232 urology & nephrology Parathyroid hormone 030209 endocrinology & metabolism Choristoma Parathyroid Glands 03 medical and health sciences 0302 clinical medicine medicine.artery Ectopic parathyroid Brachiocephalic artery Medicine Humans Supernumerary Prospective Studies Aged business.industry General Medicine Perioperative Middle Aged medicine.disease Thyroid cartilage Surgery Parathyroid Hormone Secondary hyperparathyroidism Female Hyperparathyroidism Secondary business |
| Zdroj: | International journal of surgery (London, England). 43 |
| ISSN: | 1743-9159 |
| Popis: | Objective This study was intended to demonstrate the feasibility and efficacy of purge parathyroidectomy (PPTX) for patients with secondary hyperparathyroidism (SHPT). Methods The "seed, environment, and soil" medical hypothesis was first raised, following review of the literatures, to demonstrate the possible causes of persistence or recurrence of SHPT after parathyroidectomy. Subsequently, the novel surgical strategy of PPTX was proposed, which involves comprehensive resection of the fibro-fatty tissues, including visible or invisible parathyroid, within the region surrounded by the thyroid cartilage, bilateral carotid artery sheath, and the brachiocephalic artery. The perioperative information and clinical outcomes of patients who underwent PPTX from June 2016 to December 2016 were analyzed. Results In total, PPTX was performed safely in nine patients with SHPT from June 2016 to December 2016. The operative time for PPTX ranged from 95 to 135 min, and blood loss ranged from 20 to 40 mL. No patients with perioperative death, bleeding, convulsions, or recurrent laryngeal nerve injury were reported. The preoperative concentration of PTH ranged from 1062 to 2879 pg/mL, and from 12.35 to 72.69 pg/mL on the first day after surgery. In total, 37 parathyroid glands were resected. The postoperative pathologic examination showed that supernumerary or ectopic parathyroid tissues were found within the "non-parathyroid" tissues in three patients. No cases encountered persistence or recurrence of SHPT, or severe hypocalcemia during the follow-up period. Conclusion PPTX involves comprehensive resection of supernumerary and ectopic parathyroid tissues, which may provide a more permanent means of reducing PTH levels. |
| Databáze: | OpenAIRE |
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