目的:本综述的目的是为原发性(pHPT)和肾脏(rHPT)甲状旁腺功能亢进的外科治疗提供最新建议,制定德国内分泌外科医师协会(CAEK)的新指南。
方法:多学科小组使用PubMed对pHPT和rHPT的诊断和治疗的循证建议进行了评估,以进行全面的文献检索以及结构化的共识对话(德国科学医学会协会的S2k指南,AWMF)。
结果:在过去的20年里,各种新的术前定位程序,比如Sestamibi-SPECT,4D-CT,和各种PET/CT程序,为pHPT建立。高分辨率成像,术中甲状旁腺激素(IOPTH)测量,使集中或微创手术成为最受欢迎的手术技术。pHPT和非定位成像患者多腺疾病的风险较高。手术治疗提供了非常高的治愈率,与外科医生在甲状旁腺手术中的经验有明确的关系。再次甲状旁腺切除术,有pHPT或家族形式的儿童,和甲状旁腺癌得到解决,需要特殊的外科专业知识。由经验丰富的肾病学家组成的多学科团队,移植,内分泌外科医师应评估肾脏HPT的诊断和治疗。
结论:手术是治疗pHPT的唯一方法,所有pHPT患者都应考虑手术治疗。对于rHPT,需要一种更具选择性的方法,只有当保守治疗方案失败时,才需要进行甲状旁腺切除术。在甲状旁腺癌中,局部切除的充分性影响局部疾病的控制.
OBJECTIVE: The purpose of this review is to provide updated recommendations for the surgical management of primary (pHPT) and renal (rHPT) hyperparathyroidism, formulating a new
guideline of the German Association of Endocrine Surgeons (CAEK).
METHODS: Evidence-based recommendations for the diagnosis and therapy of pHPT and rHPT were assessed by a multidisciplinary panel using PubMed for a comprehensive literature search together with a structured
consensus dialogue (S2k
guideline of the Association of the German Scientific Medical Societies, AWMF).
RESULTS: During the last 20 years, a variety of new preoperative localization procedures, such as sestamibi-SPECT, 4D-CT, and various PET/CT procedures, were established for pHPT. High-resolution imaging, together with intraoperative parathyroid hormone (IOPTH) measurement, enabled focused or minimally invasive surgery to become the most favored surgical technique. Patients with pHPT and nonlocalizing imaging have a higher risk of multiglandular disease. Surgical therapy provides very high cure rates, with a clear relation to the surgeon\'s experience in parathyroid procedures. Reoperative parathyroidectomy, children with pHPT or familial forms, and parathyroid carcinoma are addressed and require special surgical expertise. A multidisciplinary team of experienced nephrologists, transplant, and endocrine surgeons should assess the diagnosis and treatment of renal HPT.
CONCLUSIONS: Surgery is the only curative treatment for pHPT and should be considered for all patients with pHPT. For rHPT, a more selective approach is required, and parathyroidectomy is indicated only when conservative treatment options fail. In parathyroid carcinoma, the adequacy of local resection influences local disease control.