EKTOPİK PARATİROİD BEZLERİNE KLİNİK VE CERRAHİ YAKLAŞIM CLINICAL AND SURGICAL APPROACH TO ECTOPIC PARATIROID GLANDS

Yıl 2019, Cilt: 26 Sayı: 2, 221 - 227, 01.06.2019

Bilal Turan , Rasih Yazkan

https://doi.org/10.17343/sdutfd.492994

Öz

ÖZET

Ektopik paratiroid bezleri,  gözden kaçırıldıklarında, persistan veya
rekürren hiperparatiroidizmin ortak bir etiyolojisini oluştururlar. Ektopik
paratiroid bezleri, embriyogenez sürecinde anormal göçten kaynaklanır ve
başarılı bir identifikasyon olmaması paratiroid cerrahisinde başarı eksikliğine
neden olabilir. Ektopik inferior paratiroidler anterior mediastende, timus veya
tiroid bezinde en sık görülürken, ektopik superior paratiroidler için en sık
görülen pozisyon trakeoözofageal oluk ve retro özofageal bölgedir. Boyun
ultrasonografisi, 99mTc Sestamibi taraması ve tek foton emisyonlu bilgisayarlı
tomografi (SPECT) veya CT (SPECT / CT) ektopik paratiroidlerin tanısal
doğruluğunu arttıran görüntüleme yöntemleridir. Paratiroid dokusu için şüpheli
bir lezyonun ince iğne aspirasyon sitolojisi ve aspire edilen materyalin
paratiroid hormonu ölçümü ektopik bezlerin preoperatif lokalizasyonuna yardımcı
olur. Cerrahi inceleme için yaygın alanlar, üst paratiroidler için üst tiroid
kutbu, üst tiroid vasküler yapıları ve servikal özofagus, inferior
paratiroidler için karotis arter bifurkasyonu ve timustur. Radyografik olarak
başarılı lokalizasyondan sonra minimal invaziv paratiroidektomi, postoperatif
hızlı parathormon ölçümü ile desteklenerek ektopik paratiroid adenomu olan
hastalarda cerrahi sonuçları önemli ölçüde artırmaktadır.

Anahtar
kelimeler: Ektopik paratiroid, parathormon, primer
hiperparatiroidizm

ABSTRACT

Ectopic parathyroid
glands, when missed, form a common etiology of persistent or recurrent
hyperparathyroidism. Ectopic parathyroid glands originate from abnormal
migration in the embryogenesis process and lack of a successful identification
may lead to a lack of success in parathyroid surgery. While ectopic inferior
parathyroids are most common in the anterior mediastinum, thymus or thyroid
gland, the most common position for ectopic superior parathyroids is the
tracheoesophageal groove and the retro esophageal region. Neck ultrasonography, 99mTc Sestamibi
scanning and single-photon emission computed tomography (SPECT) or CT (SPECT /
CT) are imaging modalities that increase the diagnostic accuracy of ectopic
parathyroids. The fine needle aspiration cytology of the suspected lesion for
parathyroid tissue and the parathyroid hormone measurement of the aspirated
material help preoperative localization of ectopic glands. Common areas for
surgery are upper thyroid pole, upper thyroid vascular structures and cervical
esophagus for upper parathyroids and bifurcation of the carotid artery and
thymus for inferior parathyroids. After radiographic successful localization,
minimally invasive parathyroidectomy is supported by postoperative rapid
parathyroid hormone measurement, which significantly increases surgical
outcomes in patients with ectopic parathyroid adenoma.

Key
words: Ectopic parathyroid, parathormone, primary
hyperparathyroidism

Anahtar Kelimeler

Anahtar kelimeler: Ektopik paratiroid, parathormon

Kaynakça

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