摘要 目的探讨腋窝乳晕微创双切口切除术治疗甲状旁腺腺瘤的疗效。方法选取2015年1月～2017年1月我院头颈外科行腋窝乳晕微创双切口切除术治疗的甲状旁腺腺瘤患者65例作为观察组， 另选取2013年1月～2015年1月行常规开放性甲状腺切除术治疗的甲状旁腺腺瘤患者65例作为对照组，比较两组围术期指标、术后疼痛程度、并发症情况及其对手术切口美观满意度的差异。结果两组比较，观察组手术切口小，术中出血量与术后引流量少，术后住院时间短，术后24、36、48 h VAS评分明显低于对照组，差异均具有统计学意义（P<0.05）。术后观察组出现吞咽不适1例，短暂性声嘶1例，皮下气肿2例，对照组出现吞咽不适10例，短暂性声嘶3例，皮下积液2例；两组术后并发症率比较，观察组明显低于对照组，差异具有统计学意义（6.15% VS 23.08%， P<0.05）。观察组患者对手术切口美观满意度明显高于对照组，组间比较差异具有统计学意义（96.92% VS 58.46%， P<0.05）。术后随访6个月，于末次随访时复查彩超示均无复发。结论腋窝乳晕微创双切口切除术治疗甲状旁腺腺瘤的疗效满意，手术安全性较高，值得临床推广应用。
Abstract: ObjectiveTo study the curative effect and safety of minimally invasive axillary areola double incision resection for parathyroid adenoma.Methods65 patients with parathyroid adenoma treated by minimally invasive axillary areola double incision resection from our hospital during January 2015 to January 2017 were as observation group, and 65 patients with parathyroid adenoma performed conventional open thyroidectomy from January 2013 to January 2015 were selected as control group. The perioperative indicators, postoperative pain degree, complications and satisfaction of incision aesthetics were compared between two groups.ResultsCompare to the control group, the length of incision was smaller, the volume of intraoperative blood loss and postoperative suction drainage were less, the duration of postoperative hospitalization time was shorter, and the visual analogue scale (VAS) score of 24, 36 and 48 h after the surgery were lower in the observation group, and the differences were statistically (P<0.05). There was 1 case of swallowing discomfort, 1 case of transient hoarseness and 2 cases of subcutaneous emphysema in the observation group, and 10 cases of swallowing discomfort, 3 cases of transient hoarseness and 2 cases of subcutaneous hydrops in the control group. The incidences of postoperative complication of the observation group was lower than that of the control group (6.15% VS 23.08%), the satisfaction of incision aesthetics was higher in the observation group than that in the control group (96.92% VS 58.46%), and there were statistical differences between the two groups (P<0.05). All cases were followed up for 6 months, and there was no recurrence by ultrasonography exam.ConclusionThe treatment of minimally invasive axillary areola double incision resection can achieve satisfactory effect for parathyroid adenoma with safety and reliability, and it is worthy of clinical popularization.
Zeina AR, Nakar H, Reindorp D N, et al. Fourdimensional computed tomography (4DCT) for preoperative localization of parathyroid adenomas［J］. Isr Med Assoc J, 2017, 19(4):216220.
Bahl M, Sepahdari AR, Sosa JA, et al. Parathyroid adenomas and hyperplasia on fourdimensional CT scans: Three patterns of enhancement relative to the thyroid gland justify a threephase protocol［J］. Radiology, 2015, 277(2):454462. doi: 10.1148/radiol.2015142393.
Klimek L, Bergmann KC, Biedermann T, et al. Visual analogue scales (VAS): Measuring instruments for the documentation of symptoms and therapy monitoring in cases of allergic rhinitis in everyday health care: Position Paper of the German Society of Allergology (AeDA) and the German Society of Allergy and Clinical Immunology (DGAKI), ENT Section, in collaboration with the working group on Clinical Immunology, Allergology and Environmental Medicine of the German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNOKHC)［J］. Allergo J Int, 2017, 26(1):1624. doi: 10.1007/s4062901600067.
Wang X, Zhu YM, Huang H, et al. Surgery for ectopic parathyroid adenoma in lower part of superior mediastinum through a transcervical incision［J］. Chin Med J (Engl), 2017, 130(11):13761377. doi: 10.4103/03666999.206350.
［11］
Sahsamanis G, Gkouzis K, Samaras S, et al. Surgical management of a giant parathyroid adenoma through minimal invasive parathyroidectomy. A case report［J］. Int J Surg Case Rep, 2017, 31:262265. doi: 10.1016/j.ijscr.2017.01.064.
［12］
Keidar Z, Solomonov E, Karry R, et al. Preoperative ［99mTc］MIBI SPECT/CT interpretation criteria for localization of parathyroid adenomasCorrelation with surgical findings［J］. Mol Imaging Biol, 2017, 19(2):265270. doi: 10.1007/s1130701610132.
2018, Vol. 22 
