腔镜辅助微创甲状旁腺腺瘤切除术14例诊治报告  

Minimally-invasive Video-assisted Parathyroidectomy for Parathyroid Adenoma: a Report of 14 Cases

作　　者：周京安[1] 贺建业[1] 李洋[1] 

机构地区：[1]首都医科大学附属北京安贞医院普外科,北京100029

出　　处：《中国微创外科杂志》2015年第3期238-241,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腔镜辅助微创甲状旁腺腺瘤切除术（minimally-invasive video-assisted parathyroidectomy,MIVAP）的安全性与可行性。方法回顾性分析2011年4月-2014年9月我科引起原发性甲状旁腺功能亢进的甲状旁腺腺瘤14例资料,其中6例同时合并甲状腺病变。术前明确定性及定位诊断,行腔镜辅助小切口甲状旁腺腺瘤切除及甲状腺病灶切除,术中冰冻、术后免疫组化病理检查,术中、术后监测甲状旁腺激素水平变化,术后观察有无声音嘶哑、饮水呛咳、活动性出血发生。结果 14例手术均在腔镜辅助下顺利完成,术中无异常出血,无中转开放手术,手术时间35-60 min,平均50 min。术中出血量1.7-32.0 g,平均9.75 g。术后无暂时性或永久性喉返神经、喉上神经损伤和出血等并发症发生。14例术后随访2-43个月,平均16个月,均无复发。结论术前充分定性、定位,辅以术中甲状旁腺激素水平监测,腔镜辅助微创甲状旁腺腺瘤切除及甲状腺病灶切除是安全、可行的。Objective To investigate the feasibility and safety of minimally-invasive video-assisted parathyroidectomy（ MIVAP） for parathyroid adenoma（ PA）. Methods Clinical data of 14 patients with primary hyperparathyroidism（ PHPT） caused by PA between April 2011 and September 2014 in our hospital were analyzed retrospectively. Coexistent thyroid lesions were found in 6patients. With preoperative definite diagnosis and localization,we performed parathyroidectomy and local excision or lobectomy of the thyroid gland. All the patients were confirmed by intra-operative fast frozen section pathological examination and postoperative pathological immunohistochemistry. Intra- and post-operative parathyroid hormone monitoring was conducted. Hoarseness,choking cough,and active bleeding were observed. Results All the procedures were accomplished successfully,without intra-operative abnormal blood loss or conversion to conventional operation. The operative time was 35- 60 min（ mean,50 min）; the intra-operative blood loss was 1. 7- 32. 0 g（ mean,9. 75 g）. Neither transient nor everlasting injury to recurrent laryngeal nerve or superior laryngeal nerve happened. No hemorrhage was observed. All the patients were followed up for 2- 43 months（ mean,16 months）,during which there was no recurrence. Conclusion MIVAP with thyroidectomy is feasible and safe for PA and coexistent benign thyroid lesions,on the basis of pre-operative adequate diagnosis and proper localization and intra-operative parathyroid hormone monitoring.

关 键 词：腔镜辅助微创甲状旁腺手术 甲状旁腺腺瘤 原发性甲状旁腺功能亢进 

分 类 号：R736.2[医药卫生—肿瘤]