单侧颈部探查与直接微创甲状旁腺切除治疗原发性甲状旁腺功能亢进症的回顾性对比分析

Retrospective comparative analysis of unilateral neck exploration and direct minima invasive parathyroidectomy in the treatment of primary hyperparathyroidism

目的 比较单侧颈部探查(unilateral neck exploration,UNE)和直接微创甲状旁腺切除(direct minimally invasive parathyroidectomy,DMIP)治疗原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)的临床效果。方法 回顾性分析贵州省人民医院2016年1月至2021年12月期间采用术中甲状旁腺激素监测辅助下经UNE和DMIP两种手术方式治疗的87例PHPT患者的临床资料。结果 全组患者年龄(47.5±13.1岁),男24例(27.6%),女63例(72.4%)。87例患者的病理类型为甲状旁腺腺瘤78例(89.7%),甲状旁腺非典型腺瘤5例(5.7%),甲状旁腺增生4例(4.6%),无甲状旁腺癌。2例(2.3%)患者出现喉返神经损伤,3例(3.4%)患者出现术后持续性甲状旁腺功能亢进,其中1例(1.1%)患者采取了二次手术。UNE组及DMIP组患者在喉返神经损伤(2.0%比2.6%,P=0.855)和术后持续性PHPT发生率(2.0%比5.3%,P=0.713)方面比较差异无统计学意义,但DMIP组的术中出血量、手术时间、住院时间、切口长度和疼痛评分均少或短或低于UNE组,差异有统计学意义(P<0.001)。结论 DMIP治疗PHPT与UNE疗效无明显差异,但可明显缩短手术时间及住院时间,减少创伤。

Objective To compare the clinical effects of unilateral neck exploration(UNE)and direct minimally invasive parathyroidectomy(DPT)in the treatment of primary hyperparathyroidism(PHPT).Methods The clinical datas of 87 PHPT patients treated with intraoperative parathyroid hormone monitoring(IPM)assisted UNE and DMIP in Guizhou Provincial People's Hospital between January 2016 and December 2021 were analyzed retrospectively.Results The average age of patients was(47.5±13.1)years,and there were 24 males(27.6%)and 63 females(72.4%).The pathological types of 87 cases were parathyroid adenoma in 78 cases(89.7%),atypical parathyroid adenoma in 5 cases(5.7%),parathyroid hyperplasia in 4 cases(4.6%),and no parathyroid carcinoma.Two cases(2.3%)developed recurrent laryngeal nerve injury,and 3 cases(3.4%)developed postoperative persistent hyperparathyroidism,of which 1(1.1%)case underwent secondary surgery.There were no significant differences in the incidence of recurrent laryngeal nerve injury(2.0% vs.2.6%,P=0.855)and postoperative persistent hyperparathyroidism between the UNE group and the DMIP group(2.0%vs.5.3%,P=0.713).However,the intraoperative bleeding volume,operative time,hospitalization time,incision length,and pain score in the DMIP group were significantly less than or shorter than or lower than those in the UNE group(P<0.001).Conclusion There is no significant difference in the efficacy between the DMIP and UNE in the treatment of PHPT,but DMIP can significantly shorten the operative time and hospitalization time,and reduce the trauma.