原発性上皮小体機能亢進症26例に対する手術成績の検討 Review of 26 Patients Operated on for Primary Hyperparathyroidism

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原発性上皮小体機能亢進症に対して手術を施行した26例について,術前後の血清カルシウム,HS-PTH濃度の変化,および摘出標本の病理型による差異を中心に報告する.対象は平成5年4月より平成13年10月までに当科で手術を施行した26例で,これらの中に明らかな家族性高カルシウム血症,多発性内分泌腺腫症,悪性腫瘍合併症例は1例もなかった.全例,術前の画像診断にて1腺のみの腫大が認められ,全身麻酔下にて腫大腺のみの摘出を行った.その際,健側頸部の検索や.正常腺の生検は行わなかった.術後,全例で臨床症状の軽快を認め,また再手術例や永続的低カルシウム血症は生じていない.術後の血清カルシウム,HS-PTH濃度は有意に減少していた.また,永久病理標本による病理診断により腺腫群(n=16)と過形成群(n=8)の2群に分類したところ,両群とも血清カルシウム,HS-PTH濃度ともに有意に減少していた.さらに術後6カ月のHS-PTH濃度は腺腫群,過形成群で有意差を認めなかった.過形成群では術後1カ月と術後2年のHS-PTH濃度に有意差を認めなかった.その結果,家族性高カルシウム血症や多発性内分泌腺腫症のない症例で,術前の画像診断にて1腺のみの病変が疑われたものについては,腫大腺のみの摘出が腺腫,過形成の病理型によらず良好な成績を上げることが出来ると思われた.また,この術式では術後の永続的低カルシウム血症を防止できると考えられた.

The traditional surgical approach for primary hyperparathyroidism (PHP) is routine bilateral neck exploration. At Saiseikai Utsunomiya Hospital, however, unilateral exploration, and the direct resection of one gland is performed if single gland enlargement is suspected, based on the findings of several preoperative localization procedures. Here, we reviewed 26 patients who underwent single gland operations for PHP at our institution between 1993 and 2001. The 26 patients (21 women and 5 men) ranged in age from 20 to 79 years (mean. 54.8 years). None of the patients had multiple endocrine neoplasia (MEN), familial hypercalcemia, or malignant tumors. At least three preoperative localization procedures, such as ultrasonography, computed tomography, thalium technetium scanning, 99mTc sestamibi scintigraphy, or magnetic resonance imaging, were performed in each patient. A parathyroidectomy was then performed under general anesthesia. Contralateral exploration was not routinely performed. In addition, an intraoperative biopsy of the other glands was not performed. The following data were retrospectively collected in all patients: serum calcium, and the HS-PTH at one month and 6 months after the parathydectomy. All patients were normocalcemic, and the serum HS-PTH concentration significantly decreased in all patients after this operation. Patients were divided into two groups (adenoma group, n=16; hyperplasia group, n=6) and the data was analyzed according to the histological and pathological diagnosis. In both pathological groups, all patients were normocalcemic and the serum HS-PTH concentration was significantly lower after surgery. The serum HS-PTH concentration showed no significant difference between the adenoma group and the hyperplasia group at 6 months after surgery. No complications, including recurrent laryngeal nerve palsy or permanent hypocalcemia, were observed after surgery.<br>In conclusion, if a single gland disease is suspected based on the findings of multiple preoperative localization procedures, resection of the enlarged gland alone appears to provide good results for the treatment of either adenoma or hyperplasia resulting in PHP. In addition, this procedure also reduces the occurrence of postoperative hypocalcemia, because the normal glands arc not injured by the biopsy procedures',

収録刊行物

  • 日本耳鼻咽喉科學會會報

    日本耳鼻咽喉科學會會報 106(12), 1121-1126, 2003-12-20

    一般社団法人 日本耳鼻咽喉科学会

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各種コード

  • NII論文ID(NAID)
    10013989780
  • NII書誌ID(NCID)
    AN00191551
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    00306622
  • データ提供元
    CJP書誌  J-STAGE 
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