PDF(Pubmed)
Abstract：
Primary hyperparathyroidism (PHPT) usually presents with symptoms of hypercalcemia which is due to excessive secretion of parathyroid hormone (PTH). Surgical removal of the secreting tumor either adenoma or hyperplasia remains the mainstay of treatment. Around 2% to 25% of the lesions are located in the mediastinum. We reviewed our institution\'s surgical treatment and approach to mediastinal parathyroid adenoma (MPA). We retrospectively reviewed the demography, comorbidities, clinical presentation, surgical approach, and outcome for patients in our institution who underwent surgery for MPA from September 2019 until August 2023. All patients with MPA who underwent surgery were included in the review. The surgical approaches used were both video-assisted thoracoscopic surgery (VATS) and median sternotomy. There were three patients with PHPT due to MPA who underwent surgery. Out of the three patients, two were female. The mean age was 48.6 years old, ranging from 16 to 66 years old. All of them presented with PHPT with a raised mean serum calcium level of 3.52 mmol/L (range: 2.84-4.38 mmol/L) and a mean PTH or intact PTH (iPTH) level of 274.6 pmol/L (range: 8.87-695 pmol/L). Ultrasound of the neck was performed for all the patients before further investigations were done to look for the ectopic parathyroid gland. Computed tomography (CT) of the thorax showed mediastinal parathyroid mass in all the patients with an average size of 2.4 x 2.1 x 2.3cm (range: 1.3-3.8cm), which showed uptake in 99mTc-hexakis-2-methoxyisobuthylisonitrile (Tc99m-MIBI) scintigraphy. VATS was performed for two cases and an upper partial sternotomy was performed for one patient. Postoperatively, iPTH and serum calcium levels were reduced significantly for all patients. There were no post-operative complications in our study. Comprehensive diagnostic imaging and surgical planning are important for the localization of MPA. In our review, all cases were promptly diagnosed and underwent surgery without complication.
摘要：
原发性甲状旁腺功能亢进（PHPT）通常表现为高钙血症的症状，这是由于甲状旁腺激素（PTH）的过度分泌。手术切除分泌性肿瘤腺瘤或增生仍然是治疗的主要手段。大约2％至25％的病变位于纵隔。我们回顾了我们机构的手术治疗和纵隔甲状旁腺腺瘤（MPA）的方法。我们回顾了人口统计学，合并症,临床表现,手术方法,和我们机构从2019年9月至2023年8月接受MPA手术的患者的结局。所有接受手术的MPA患者均纳入审查。所使用的手术方法包括电视胸腔镜手术（VATS）和正中胸骨切开术。有3例因MPA而接受PHPT手术的患者。在三个病人中，两个是女性。平均年龄是48.6岁,年龄从16岁到66岁不等。所有患者均出现PHPT，平均血清钙水平升高为3.52mmol/L（范围：2.84-4.38mmol/L），平均PTH或完整PTH（iPTH）水平为274.6pmol/L（范围：8.87-695pmol/L）。在进行进一步检查以寻找异位甲状旁腺之前，对所有患者进行了颈部超声检查。胸部计算机断层扫描（CT）显示所有患者的纵隔甲状旁腺肿块平均大小为2.4x2.1x2.3cm（范围：1.3-3.8cm），在99mTc-六-2-甲氧基异丁二腈（Tc99m-MIBI）闪烁显像中显示摄取。对2例患者进行了VATS，对1例患者进行了胸骨上部分切开术。术后,所有患者的iPTH和血清钙水平均显着降低。我们的研究中没有术后并发症。全面的诊断成像和手术计划对于MPA的定位很重要。在我们的审查中,所有病例均得到及时诊断和手术治疗,无并发症发生.
