EFFECTS OF PREOPERATIVE FINDINGS ON POSTOPERATIVE RESULTS IN PATIENTS UNDERGOING SURGERY FOR PRIMARY HYPERPARATHYROIDISM

Year 2023, Volume: 30 Issue: 1, 97 - 105, 14.03.2023

İsmail Hasırcı Çetin Kotan

https://doi.org/10.17343/sdutfd.1229962

Abstract

Objective
To investigate the success of imaging methods and
the effect of preoperative findings on postoperative
results in patients who underwent surgery for primary
hyperparathyroidism (p-HPT).
Material and Method
In this study, the data of 50 consecutive patients who
underwent p-HPT surgery at the General Surgery
Clinic of Yuzuncu Yil University Faculty of Medicine
between January 2008 and December 2010 were
prospectively analyzed. During the study period,
the patients’ demographic data, clinical findings,
preoperative and postoperative laboratory results,
findings of ultrasonography, scintigraphy, and
computed tomography performed for localization in
the preoperative period, and surgery and pathology
reports were evaluated and recorded. The obtained
data were statistically analyzed.
Results
Musculoskeletal pain was the most common (80%)
reason for the patients’ presentation to the hospital.
In the operated patients, the serum parathormone
and calcium levels significantly decreased compared
to the preoperative period (p<0.05). The rate of
patients who underwent bilateral neck dissection
was 30%. In the histopathological examination of the
glands, adenoma lesions were detected in 88% of the
patients, and the rate of those with a pathology result
of parathyroid hyperplasia was 12%. In addition,
4% of the patients had ectopic pathological glands
(retroesophageal, anterior mediastinum), and 4% had
double adenomas. The sensitivity of ultrasonography
in detecting pathological glands was calculated as
72%. However, ultrasonography did not accurately
localize all ectopic (4%) and double adenoma (4%)
lesions. The postoperative calcium values were similar
between the patients that underwent simultaneous
thyroidectomy and those that did not undergo this
operation, but the parathormone values measured on
the second postoperative day were significantly lower
in the former.
Conclusion
Although ultrasonography has a high diagnostic
value, it can cause mislocalization in the presence
of multiple lesions with atypical localization. The risk
of postoperative hypocalcemia increases as surgical
exploration increases.

Keywords

Endocrine surgery, Parathyroid adenoma, Hyperparathyroidism

PRİMER HİPERPARATİROİDİ CERRAHİSİ GEÇİREN HASTALARDA PREOPERATİF VE PEROPERATİF PARAMETRELERİN KARŞILAŞTIRILMASI, PREOPERATİF PARAMETRELERİN POSTOPERATİF SEYRİ ÜZERİNE ETKİSİ

Abstract

Amaç
Çalışmamızda, primer hiperparatiroidi (p-HPT) nedeni
ile opere edilen hastalarda görüntüleme yöntemlerinin
başarısı ve preoperatif bulguların postoperatif
sonuçlara etkisi araştırıldı.
Gereç ve Yöntem
Bu çalışmada Ocak 2008 ile Aralık 2010 tarihleri arasında
Yüzüncü Yıl Üniversitesi Tıp Fakültesi Genel
Cerrahi kliniği tarafından p-HPT nedeni ile opere edilen
50 ardışık olgunun verileri prospektif olarak incelendi.
Çalışma süresi boyunca hastaların demografik
verileri, klinik bulguları, ameliyat öncesi ve sonrası
laboratuvar sonuçları, ameliyat öncesi dönemde lokalizasyon
amacıyla yapılan ultrasonografi (USG),
sintigrafi ve bilgisayarlı tomografi (BT) bulguları, ameliyat
ve patoloji raporları incelendi ve kaydedildi. Elde
edilen veriler istatistiksel olarak analiz edildi.
Bulgular
Kas iskelet sistemi ağrılarının en sık (%80) hastaneye
başvuru nedeni olduğu görüldü. Opere edilen hastalarda
ameliyat sonrası serum parathormon (PTH) ve
kalsiyum seviyelerinin ameliyat öncesi döneme göre
anlamlı oranda düştüğü tespit edildi (p<0.05). İki taraflı
boyun diseksiyonu yapılan hastaların oranı %30
idi. Bezlerin histopatolojik incelemesinde hastaların %
88’inde adenom tespit edilirken paratiroid hiperplazisi
olarak rapor edilenlerin oranı ise % 12 idi. Ayrıca
hastaların % 4’ünde patolojik bezler ektopik yerleşimli
(retroözofagial, ön mediasten) iken, % 4 hastada ise
çift adenom mevcut idi. USG’nin patolojik bezleri tespit
etmedeki sensitivitesi %72 olarak hesaplandı. Bununla
birlikte USG’nin ektopik yerleşimli (%4) ve çift
adenom (%4) olan lezyonların tamamında doğru lokalizasyon
yapamadığı görüldü. Eş zamanlı tiroidektomi
yapılan hastalarda, ameliyat sonrası kalsiyum değerleri
tiroidektomi yapılmayanlara benzerken 2. gün
PTH değeri daha düşük bulunmuştur.
Sonuç
Ultrasonografi yüksek tanısal değere sahip olmakla
birlikte atipik yerleşimli, multipl lezyonlarda yanlış lokalizasyona
sebep olabilmektedir. Cerrahi eksplorasyon
arttıkça postop hipokalsemi riski artmaktadır.

Keywords

Endokrin cerrahi, Paratiroid adenomu, Hiperparatiroidi.

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