Operative strategie bei persistenz und rezidiv in der chirurgie des prim�ren hyperparathyreoidismus

Abstract

Persisting hypercalcemia after surgery for primary hyperparathyroidism is a challenge for the surgeon: once non-parathyroid causes for the hypercalcemia have been excluded the only remaining possible causes are ineffective surgery and a failed surgery. Between 1986 and 1994, 414 patients with primary hyperparathyroidism were operated upon, 32 of whom presented with persisting hypercalcemia; 24 of these patients had their first operation in another hospital. The cause for persisting hypercalcemia was a single adenoma in 27 patients (84%), double adenoma in 2 patients and primary hyperplasia in 2 patients. In 1 patient an unsuccessful revision operation was performed. In 17 patients the parathyroid glands had an atypical position. There were 11 patients who presented with recurrent hyperplasia. The reasons for recurrence were double adenoma in 2 patients and hyperplasia in 8 cases (73%). In 1 patient no pathologic gland was found. Although preoperative localization studies were positive in only 32%, the overall surgical success rate fortunately amounted to a satisfactory 95%.

Impact of “Tailored” Parathyroidectomy for Treatment of Primary Hyperparathyroidism in Patients with Multiple Endocrine Neoplasia Type 1

“…In other studies, the permanent hypoparathyroidism rate was about 60 and 20-40% in TPTX and SPTX, respectively [9][10][11]. Many reports therefore concluded that SPTX was more effective than TPTX for preventing postoperative hypoparathyroidism in patients with MEN1 [7,9,10,[13][14][15][16]19]. In contrast, a review by Thakker et al [5] recommended TPTX, while a report by Tonelli et al [8] suggested that both SPTX and TPTX with an intraoperative PTH assay are acceptable.…”

Ergebnisse der operativen Therapie beim renalen Hyperparathyreoidismus Verlaufsbeobachtungen bei 143 Patienten

“…Leider wird nicht immer genau zwischen Persistenz und Rezidiv differenziert. Eine Transplantatreduktion am Arm ist f/jr den Patienten ein wenig belastender, in Lokalan~isthesie durchf/jhrbarer Eingriff, im Gegensatz zum Rezidiveingriff am Hals, der in Vollnarkose vorgenommen werden mug und ein nicht zu untersch~itzendes Risiko einer Recurrensparese in sich birgt [8]. F/Jr den Chirurgen gestalten sich beide Eingriffe problematisch: Das periphere Autotransplantat w~ichst infiltrierend in den Muskel und erschwert so seine Abgrenzung.…”