Primer hiperparatiroidizm için cerrahi tedavi sonuçlarının değerlendirilmesi: Tek merkez deneyimi

Abstract

AMAÇ: Primer hiperparatiroidizm (PHPT), dört paratiroid bezinin bir veya daha fazlasından aşırı paratiroid hormonu (PTH) salgılanmasıyla karakterize bir hastalıktır. Anormal paratiroid bezlerinin cerrahi olarak çıkarılması, hastalığın en etkili tedavi yötemidir. Bu çalışma, PHPT nedeniyle ameliyat edilen hastaların klinik ve cerrahi deneyimlerimizi sunmayı amaçlamaktadır. GEREÇ VE YÖNTEM: Ocak 2014 - Mart 2019 tarihleri arasında hastanemiz meme ve endokrin cerrahisi bölümünde PHPT tanısı ile ameliyat edilen hastaların verileri geriye dönük olarak incelendi. BULGULAR: Bu çalışmaya medyan yaşı 54 olan toplam 334 hasta (dağılım 16-86) dahil edildi. Bunlardan 165'i (% 81,7) kadın, 37'si (% 18,3) erkekti. Preoperatif lokalizasyon çalışmalarında, en yüksek doğru tespit oranı, anormal paratiroid bezlerinin % 85.7'sini tanımlayan sestamibili tek foton emisyonlu bilgisayarlı tomografi ve ultrasonografi ile elde edildi. Hastaların % 22.16'sında minimal invaziv yöntem, %76,94'ünde bilateral boyun eksplorasyonu tercih edildi. 3 hastada sternotomi gerekti. Patolojik bezlerin ektopik lokalizasyonu 26 (% 7.788) hastada mevcuttu. Eş zamanlı tiroidektomi 124 (% 37.12) hastaya uygulandı. 14 (% 11.29) hastada rastlantısal tiroid maligniteleri teşhis edildi. Persitent ve rekürren hastalık görülme sıklıkları sırasıyla 6.88% ve 4.19% olarak tespit edildi. SONUÇ: PHPT, multidisipliner bir yaklaşım gerektirir. Cerrahi tedavi, düşük komplikasyon oranları ile% 95'in üzerinde iyileşme sağlayabilir. Anormal bezler için dikkatli lokalizasyon çalışmaları ve eşlik eden tiroid patolojileri için ayrıntılı incelemelerin ameliyat başarısını daha da artıracağına inanıyoruz.

Keywords

• Pimer hiperparatiroidizm
• paratiroid lokalizasyonu
• paratiroidektomi
• cerrahi

Evaluation of surgical treatment outcomes for primary hyperthyroidism: A single center experience

Abstract

AIM: Primary hyperparathyroidism (PHPT) is a disease characterized by excess parathyroid hormone (PTH) secretion from one or more of the four parathyroid glands. Surgical removal of abnormal parathyroid glands is the most effective treatment method for the disease. This study aims to present our clinical and surgical experience of patients operated on for PHPT. MATERIAL AND METHOD: The data of patients who were operated with a diagnosis of PHPT in the breast and endocrine surgery department of our hospital between January 2014 and March 2019 were retrospectively analyzed. RESULTS: A total of 334 patients (range 16 to 86) with a median age of 54 were included in this study. Of these, 165 (81.7%) were female and 37 (18.3%) were male. In preoperative localization studies, the highest accurate detection rate was obtained sestamibi with single-photon emission computed tomography and ultrasonography, which defined 85.7% of abnormal parathyroid glands. Minimally invasive method was preferred in 22.16% of the patients, and bilateral neck exploration was preferred in 76.94% of the patients. Sternotomy was required in 3 patients. Ectopic localization of pathological glands was present in 26 (7.788%) patients. Concomitant thyroidectomy was performed in 124 (37.12%) patients. Incidental thyroid malignancies were diagnosed in 14 (11.29%) patients. The prevalence of persistent and recurrent disease was determined as 6.88% and 4.19%, respectively. CONCLUSION: PHPT requires a multidisciplinary approach. Surgical treatment can provide over 95% improvement with low complication rates. We believe that careful localization studies for abnormal glands and detailed examinations for accompanying thyroid pathologies will further incress the the surgery success.

Keywords

• primary hyperparathyroidism
• parathyroid localization
• parathyroidectomy
• surgery

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