背景:随着当前世界人口的老龄化,原发性甲状旁腺功能亢进的诊断报告越来越多的老年患者,与相关的功能症状学加剧了年龄的变迁。这项回顾性研究旨在建立在局部麻醉下作为门诊手术的甲状旁腺腺瘤切除术后老年患者的功能改善。
方法:收集了53例接受微创甲状旁腺腺瘤切除术的80岁或以上患者的数据。所有患者都接受了术前超声检查,闪烁显像,并在5min时根据甲状旁腺激素(PTH)的给药前后监测手术的有效性,2h和4h。
结果:术前平均血清钙水平为2.8mmol/L(112mg/L),平均PTH为180pg/ml。38例患者在局部麻醉下使用微创手术进行手术,18例患者在全身麻醉下进行手术。在26个案例中,手术计划在门诊进行,但只能在21例患者中进行.51例患者在术后即刻血清钙和PTH水平正常。两名患者在全身麻醉下再次手术,因为术后即刻PTH没有恢复正常。4例患者死于与甲状旁腺功能亢进无关的原因。5例患者在术后6个月至2年失去随访。在44名接受PTH长期监测的患者(83%)中,没有人出现生物学性甲状旁腺功能亢进的复发。不包括三名无症状患者,长期随访的41例有症状患者中有38例(93%)认为自己在干预后“改善”或“强烈改善”。特别是在疲劳方面,肌肉和骨骼疼痛。两名患者(4.9%)报告没有差异,一名患者(2.4%)说她的病情恶化并后悔接受了手术。
结论:在80岁或以上的患者中,微创手术作为门诊病人在局部麻醉下提供了极好的风险/效益比,因为它有许多优点:简单,速度,没有全身麻醉,易于监控,术中直接语音控制,发病率非常低,在超过95%的初诊患者中治疗原发性甲状旁腺功能亢进的有效性,以及在多腺疾病未被注意到的情况下立即或延迟恢复的可能性。
BACKGROUND: With the current aging of the world\'s population, diagnosis of primary hyperparathyroidism is being reported in increasingly older patients, with the associated functional symptomatology exacerbating the vicissitudes of age. This retrospective study was designed to establish functional improvements in older patients following parathyroid adenomectomy under local anesthesia as outpatient surgery.
METHODS: Data were collected from 53 patients aged 80 years or older who underwent a minimally invasive parathyroid adenomectomy. All patients underwent a preoperative ultrasound, scintigraphy, and were monitored for the effectiveness of the procedure according to intra- and postdosage of parathyroid hormone (PTH) at 5min, 2h and 4h.
RESULTS: Mean preoperative serum calcium level was 2.8mmol/L (112mg/L) and mean PTH was 180pg/ml. Thirty-eight patients were operated under local anesthesia using minimally invasive surgery and 18 patients were operated under general anesthesia. In 26 cases, the procedure was planned on an outpatient basis but could only be carried out in 21 patients. Fifty-one patients had normal serum calcium and PTH levels during the immediate postoperative period. Two patients were reoperated under general anesthesia, since immediate postoperative PTH did not return to normal. Four patients died due to reasons unrelated to hyperparathyroidism. Five patients were lost to follow-up six months to two years postsurgery. Of the 44 patients (83%) with long-term monitoring for PTH, none had recurrence of biological hyperparathyroidism. Excluding the three asymptomatic patients, 38 of the 41 symptomatic patients (93%) with long-term follow-up were considering themselves as \"improved\" or \"strongly improved\" after the intervention, notably with respect to fatigue, muscle and bone pain. Two patients (4.9%) reported no difference and one patient (2.4%) said her condition had worsened and regretted having undergone surgery.
CONCLUSIONS: In patients 80 years or older, minimally invasive surgery as an outpatient under local anesthesia offered an excellent risk/benefit ratio given its many advantages: simplicity, speed, absence of general anesthesia, ease of monitoring, direct voice control intraoperatively, very low morbidity, effectiveness in treating primary hyperparathyroidism in more than 95% of first intention patients, and the possibility of immediate or delayed recovery in the event of multiglandular disease going unnoticed.