腔镜甲状旁腺切除术在原发性甲状旁腺功能亢进症治疗中的应用  

Application of Endoscopic Parathyroidectomy in the Treatment of Primary Hyperparathyroidism

作　　者：花苏榕[1] 王智弘 高俊义[1] 王梦一[1] 刘乔飞[1] 刘雯静[1] 葛冠男[1] 韦颖昕 胡亚[1] 廖泉[1] Hua Surong;Wang Zhihong;Gao Junyi;Wang Mengyi;Liu Qiaofei;Liu Wenjing;Ge Guannan;Wei Yingxin;Hu Ya;Liao Quan(Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院基本外科,北京100730 [2]中国医学科学院北京协和医学院,北京100730

出　　处：《中华内分泌外科杂志》2022年第4期391-395,共5页Chinese Journal of Endocrine Surgery

基　　金：中国医学科学院医学与健康科技创新工程项目 (2021-I2M-1-002)。

摘　　要：目的总结原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)患者接受腔镜甲状旁腺切除术的临床资料及经验。方法回顾性纳入2021年2月至2022年5月北京协和医院基本外科因PHPT接受腔镜甲状旁腺切除术共24例患者的临床资料,其中20例为经腋窝入路,4例为经胸乳入路,观察手术时间、术后引流量、住院时间,术前术后甲状旁腺激素与血清钙的差异,并随访术后的并发症与复发情况。应用R 3.7.0软件进行分析。计量资料以平均数±标准差(x±s)表示,使用配对t检验对术前、术后的资料进行检验及分析。计数资料则采用独立样本χ^(2)检验。结果术后血清甲状旁腺激素和血清钙水平均降低至术前的50%水平以下(P<0.05)。经腋窝手术时间为(96±22)min,范围为64~157 min,经胸乳手术因例数过少未纳入手术时间统计。术后引流量分别为第1天(47±16)ml、第2天(46±11)ml、第3天(30±9)ml。术后住院时间为(2.8±1.1)d,范围为2~6 d。有1例经腋窝入路手术因病变位置过低而中转开放手术,其他病例均在腔镜下完成,获得了满意的治疗效果。所有病例未出现术后出血、永久性声音嘶哑、饮水呛咳、术区感染等并发症。随访时间为(7.4±4.2)个月,范围为1~16个月,随访期间患者均无明显不适,未见复发。结论腔镜甲状旁腺切除术在PHPT的治疗中安全有效,可作为有美容要求患者手术术式的一种选择。Objective To summarize the experience and the clinical data of patients with primary hyperparathyroidism undergoing endoscopic parathyroidectomy.Methods A total of 24 patients who underwent endoscopic parathyroidectomy for primary hyperparathyroidism in Peking Union Medical College Hospital during Feb.2021 to May.2022 were concluded in this study(20 cases of parathyroidectomy via axillary approach and 4 cases of parathyroidectomy via thoracic and breast approach).The operation time,postoperative drainage,length of stay,level of parathyroid hormone and serum calcium of those patients were collected.Postoperative complications and recurrence of hyperparathyroidism were also observed.Results The postoperative levels of serum parathyroid hormone and serum calcium were significantly reduced(over 50%)compared with preoperative level(P<0.05).The average operation time was(96±22)min(64-157 min).The mean postoperative drainage volume was(47±16)ml on day 1,(46±11)ml on day 2,and(30±9)ml on day 3,respectively.The average length of postoperative hospital stay was(2.8±1.1)days(2-6 days).In one case of parathyroidectomy via axillary approach,the operation was converted to open surgery because of the low position of lesion.Other cases completed endoscopic surgery and obtained satisfactory cosmetic results.There were no postoperative complications such as bleeding,permanent hoarseness,coughing while drinking water,or surgical site infection.The mean follow-up time was(7.4±4.2)months(1-16 months).There was no obvious discomfort and no recurrence during follow-up.Conclusion Endoscopic parathyroidectomy is safe and effective in the treatment of primary hyperparathyroidism,which can be used as a surgical option for patients with cosmetic requirements.

关 键 词：原发性甲状旁腺功能亢进症 腔镜甲状旁腺切除术 

分 类 号：R653[医药卫生—外科学]