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目的探讨颈部小切口直接甲状旁腺腺瘤切除术治疗原发性甲状旁腺功能亢进的效果。方法回顾性分析笔者所在医院2005年1月至2014年12月期间收治的行小切口直接甲状旁腺腺瘤切除术的18例原发性甲状旁腺功能亢进患者的临床资料。结果 18例原发性甲状旁腺功能亢进病例中包括骨型12例,肾型6例。所有患者术前经99Tcm-锝-甲氧基异丁基异腈放射性核素双时相显像(99Tcm-MIBI)和彩超检查准确定位,均行小切口直接甲状旁腺腺瘤切除术,均顺利切除肿瘤。其中下位甲状旁腺腺瘤11例(切口均取颈部胸骨柄以上两横指处的横弧形切口),上位甲状旁腺腺瘤7例(切口均取肿瘤表面沿皮纹的横切口)。全部病例的手术过程均顺利,手术时间33~62 min、(42.45±8.14)min;术中出血量13~27 m L、(19.39±4.24)m L。术后病理学检查结果均为原发性甲状旁腺腺瘤,腺瘤直径1.0~2.5 cm、(2.03±0.46)cm,全部为功能性腺瘤。17例于术后1~3 d出现暂时性颜面或手足麻木,1例于术后当天出现皮下血肿。术后17例患者获访,随访时间4~123个月,中位数为57个月。1例于术后49个月再次出现原发性甲状旁腺功能亢进症状,余16例患者术后恢复良好,未再出现原发性甲状旁腺功能亢进症状。结论小切口直接甲状旁腺腺瘤切除术治疗原发性甲状旁腺功能亢进的效果确切,其手术创伤小,并发症少,能达到微创美观的效果。施术时术者应选择合适的切口位置,并熟练掌握甲状旁腺的解剖关系。
Objective To investigate the effect of small neck incision direct parathyroid adenoma in the treatment of primary hyperparathyroidism. Methods The clinical data of 18 patients with primary hyperparathyroidism undergoing small incision direct parathyroid adenoma resection from January 2005 to December 2014 in our hospital were retrospectively analyzed. Results 18 cases of primary hyperparathyroidism including bone in 12 cases, 6 cases of renal type. All patients were accurately positioned by 99Tcm-technetium-methoxyisobutyronitriles radionuclide dual-phase imaging (99Tcm-MIBI) and color Doppler ultrasonography before operation. All patients underwent small-incision direct parathyroid adenoma resection and were successfully resected Tumor. Among them, 11 cases had hypoparathyroid adenoma (all the transverse arc-shaped incisions above the two transverse fingers of the sternum of the neck) and 7 cases of the upper parathyroid adenoma (the incision was taken along the transverse incision of the dermis along the surface of the tumor) . The surgical procedure was successful in all cases. The operative time ranged from 33 to 62 minutes (42.45 ± 8.14) min. The intraoperative blood loss was 13 to 27 m L (19.39 ± 4.24) m L. Postoperative pathological findings were primary parathyroid adenoma, adenoma diameter 1.0 ~ 2.5 cm, (2.03 ± 0.46) cm, all of the functional adenoma. There were 17 cases of temporary facial or hand-foot numbness 1-3 days after operation and 1 case of subcutaneous hematoma on the day after operation. Seventeen patients were followed up for 4 ~ 123 months with a median of 57 months. One case showed primary hyperparathyroidism again 49 months after operation, and the remaining 16 cases recovered well after operation. Primary hyperparathyroidism did not recur. Conclusion Small incision direct parathyroid adenoma resection for the treatment of primary hyperparathyroidism exact effect of its surgical trauma, fewer complications, to achieve minimally invasive aesthetics. Surgery patients should choose the appropriate incision position, and proficiency in the anatomy of parathyroid.