纵隔内异位甲状旁腺功能亢进症的诊治体会：附3例报道_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

张文 ^1,2 , 陈和丹 ¹ , 王艺超 ¹ , 雷建勇 ¹ ,  李志辉 ¹

1. ;
2. ;

Corresponding author：

李志辉, Email: rockoliver@vip.sina.com

Keywords：

异位甲状旁腺; 继发性甲状旁腺功能亢进症; 三发性甲状旁腺功能亢进症; 二次手术

DOI：

10.7507/1007-9424.202206016

Video：

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目的分析纵隔内异位甲状旁腺功能亢进症2次手术的原因及防治策略。方法回顾性收集四川大学华西医院（简称“我院”）甲状腺外科2021年11月至2022年3月期间收治的三发性甲状旁腺功能亢进症患者的临床病理资料。结果共收集到3例患者即病例1~3，其中病例1和病例3为女性，病例2为男性，年龄分别为61、48及57岁。3例患者均因肾功能衰竭行维持性血液透析分别达13、10及9年。病例1和2初次均于外院经第1次行甲状旁腺切除+甲状旁腺自体移植术后甲状旁腺激素（parathyroid hormone，PTH）未持续下降而入我院治疗，发现纵隔内异位甲状旁腺，经评估后行机器人或胸腔镜下甲状旁腺瘤切除术，术后PTH显著下降，骨痛症状显著缓解。病例3初次因骨痛就诊于外院（具体不详）给予口服药物对症治疗后PTH仍持续偏高而入我院治疗，发现颈部及纵隔内异位甲状旁腺，经综合评估后行经颈甲状旁腺切除联合胸腔镜纵隔内甲状旁腺肿物切除，术后PTH下降显著，骨痛症状显著缓解。结论对于纵隔内异位甲状旁腺功能亢进症患者，术前联合多途径检查充分评估，选择合适的手术方式，若条件许可行微创治疗，必要时联合术中PTH检测，以减少再次手术风险。

Citation： 张文, 陈和丹, 王艺超, 雷建勇, 李志辉. 纵隔内异位甲状旁腺功能亢进症的诊治体会：附3例报道. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(1): 80-83. doi: 10.7507/1007-9424.202206016 Copy

1.	中华医学会骨质疏松和骨矿盐疾病分会, 中华医学会内分泌分会代谢性骨病学组. 原发性甲状旁腺功能亢进症诊疗指南. 中华骨质疏松和骨矿盐疾病杂志, 2014, 7(3): 187-198.
2.	中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 慢性肾脏病继发甲状旁腺功能亢进外科临床实践中国专家共识(2021版). 中国实用外科杂志, 2021, 41(8): 841-848.
3.	Ozkan ZG, Unal SN, Kuyumcu S, et al. Clinical utility of Tc-99m MIBI SPECT/CT for preoperative localization of parathyroid lesions. Indian J Surg, 2017, 79(4): 312-318.
4.	Ketteler M, Block GA, Evenepoel P, et al. Diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder: synopsis of the kidney disease: improving global outcomes 2017 clinical practice guideline update. Ann Intern Med, 2018, 168(6): 422-430.
5.	Fukagawa M, Yokoyama K, Koiwa F, et al. Clinical practice guideline for the management of chronic kidney disease-mineral and bone disorder. Ther Apher Dial, 2013, 17(3): 247-288.
6.	Pitt SC, Panneerselvan R, Chen H, et al. Tertiary hyperparathyroidism: is less than a subtotal resection ever appropriate? A study of long-term outcomes. Surgery, 2009, 146(6): 1130-1137.
7.	Gioviale MC, Bellavia M, Damiano G, et al. Post-transplantation tertiary hyperparathyroidism. Ann Transplant, 2012, 17(3): 111-119.
8.	Grevellec A, Tucker AS. The pharyngeal pouches and clefts: development, evolution, structure and derivatives. Semin Cell Dev Biol, 2010, 21(3): 325-332.
9.	Schneider R, Slater EP, Karakas E, et al. Initial parathyroid surgery in 606 patients with renal hyperparathyroidism. World J Surg, 2012, 36(2): 318-326.
10.	Conzo G, Perna AF, Sinisi AA, et al. Total parathyroidectomy without autotransplantation in the surgical treatment of secondary hyperparathyroidism of chronic kidney disease. J Endocrinol Invest, 2012, 35(1): 8-13.
11.	Shih ML, Duh QY, Hsieh CB, et al. Total parathyroidectomy without autotransplantation for secondary hyperparathyroidism. World J Surg, 2009, 33(2): 248-254.
12.	Puccini M, Carpi A, Cupisti A, et al. Total parathyroidectomy without autotransplantation for the treatment of secondary hyperparathyroidism associated with chronic kidney disease: clinical and laboratory long-term follow-up. Biomed Pharmacother, 2010, 64(5): 359-362.
13.	Stracke S, Jehle PM, Sturm D, et al. Clinical course after total parathyroidectomy without autotransplantation in patients with end-stage renal failure. Am J Kidney Dis, 1999, 33(2): 304-311.
14.	Pattou FN, Pellissier LC, Noël C, et al. Supernumerary parathyroid glands: frequency and surgical significance in treatment of renal hyperparathyroidism. World J Surg, 2000, 24(11): 1330-1334.
15.	Welch K, McHenry CR. The role of transcervical thymectomy in patients with hyperparathyroidism. Am J Surg, 2012, 203(3): 292-295.
16.	Li C, Lv L, Wang H, et al. Total parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: systematic review and meta-analysis. Ren Fail, 2017, 39(1): 678-687.
17.	Yuan Q, Liao Y, Zhou R, et al. Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: an updated systematic review and meta-analysis. Langenbecks Arch Surg, 2019, 404(6): 669-679.
18.	Hou J, Shan H, Zhang Y, et al. Network meta-analysis of surgical treatment for secondary hyperparathyroidism. Am J Otolaryngol, 2020, 41(2): 102370. doi: 10.1016/j.amjoto.2019.102370.
19.	Patow CA, Norton JA, Brennan MF. Vocal cord paralysis and reoperative parathyroidectomy. A prospective study. Ann Surg, 1986, 203(3): 282-285.
20.	Nafisi-Moghadam R, Amlelshahbaz AP, Namiranian N, et al. comparative diagnostic performance of ultrasonography and ^99mTc-sestamibi scintigraphy for parathyroid adenoma in primary hyperparathyroidism; systematic review and meta-analysis. Asian Pac J Cancer Prev, 2017, 18(12): 3195-3200.
21.	Noda S, Onoda N, Kashiwagi S, et al. Strategy of operative treatment of hyperparathyroidism using US scan and^99mTc-MIBI SPECT/CT. Endocr J, 2014, 61(3): 225-230.
22.	Medas F, Cappellacci F, Canu GL, et al. The role of Rapid Intraoperative Parathyroid Hormone (ioPTH) assay in determining outcome of parathyroidectomy in primary hyperparathyroidism: a systematic review and meta-analysis. Int J Surg, 2021, 92: 106042. doi: 10.1016/j.ijsu.2021.106042.
23.	Isaacs KE, Belete S, Miller BJ, et al. Video-assisted thoracoscopic surgery for ectopic mediastinal parathyroid adenoma. BJS Open, 2019, 3(6): 743-749.
24.	Du H, Shi M, Zhu L, et al. Comparison of video-assisted thoracic surgery with open surgery in the treatment of ectopic mediastinal parathyroid tumors. J Thorac Dis, 2017, 9(12): 5171-5175.

1. 中华医学会骨质疏松和骨矿盐疾病分会, 中华医学会内分泌分会代谢性骨病学组. 原发性甲状旁腺功能亢进症诊疗指南. 中华骨质疏松和骨矿盐疾病杂志, 2014, 7(3): 187-198.
2. 中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 慢性肾脏病继发甲状旁腺功能亢进外科临床实践中国专家共识(2021版). 中国实用外科杂志, 2021, 41(8): 841-848.
3. Ozkan ZG, Unal SN, Kuyumcu S, et al. Clinical utility of Tc-99m MIBI SPECT/CT for preoperative localization of parathyroid lesions. Indian J Surg, 2017, 79(4): 312-318.
4. Ketteler M, Block GA, Evenepoel P, et al. Diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder: synopsis of the kidney disease: improving global outcomes 2017 clinical practice guideline update. Ann Intern Med, 2018, 168(6): 422-430.
5. Fukagawa M, Yokoyama K, Koiwa F, et al. Clinical practice guideline for the management of chronic kidney disease-mineral and bone disorder. Ther Apher Dial, 2013, 17(3): 247-288.
6. Pitt SC, Panneerselvan R, Chen H, et al. Tertiary hyperparathyroidism: is less than a subtotal resection ever appropriate? A study of long-term outcomes. Surgery, 2009, 146(6): 1130-1137.
7. Gioviale MC, Bellavia M, Damiano G, et al. Post-transplantation tertiary hyperparathyroidism. Ann Transplant, 2012, 17(3): 111-119.
8. Grevellec A, Tucker AS. The pharyngeal pouches and clefts: development, evolution, structure and derivatives. Semin Cell Dev Biol, 2010, 21(3): 325-332.
9. Schneider R, Slater EP, Karakas E, et al. Initial parathyroid surgery in 606 patients with renal hyperparathyroidism. World J Surg, 2012, 36(2): 318-326.
10. Conzo G, Perna AF, Sinisi AA, et al. Total parathyroidectomy without autotransplantation in the surgical treatment of secondary hyperparathyroidism of chronic kidney disease. J Endocrinol Invest, 2012, 35(1): 8-13.
11. Shih ML, Duh QY, Hsieh CB, et al. Total parathyroidectomy without autotransplantation for secondary hyperparathyroidism. World J Surg, 2009, 33(2): 248-254.
12. Puccini M, Carpi A, Cupisti A, et al. Total parathyroidectomy without autotransplantation for the treatment of secondary hyperparathyroidism associated with chronic kidney disease: clinical and laboratory long-term follow-up. Biomed Pharmacother, 2010, 64(5): 359-362.
13. Stracke S, Jehle PM, Sturm D, et al. Clinical course after total parathyroidectomy without autotransplantation in patients with end-stage renal failure. Am J Kidney Dis, 1999, 33(2): 304-311.
14. Pattou FN, Pellissier LC, Noël C, et al. Supernumerary parathyroid glands: frequency and surgical significance in treatment of renal hyperparathyroidism. World J Surg, 2000, 24(11): 1330-1334.
15. Welch K, McHenry CR. The role of transcervical thymectomy in patients with hyperparathyroidism. Am J Surg, 2012, 203(3): 292-295.
16. Li C, Lv L, Wang H, et al. Total parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: systematic review and meta-analysis. Ren Fail, 2017, 39(1): 678-687.
17. Yuan Q, Liao Y, Zhou R, et al. Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: an updated systematic review and meta-analysis. Langenbecks Arch Surg, 2019, 404(6): 669-679.
18. Hou J, Shan H, Zhang Y, et al. Network meta-analysis of surgical treatment for secondary hyperparathyroidism. Am J Otolaryngol, 2020, 41(2): 102370. doi: 10.1016/j.amjoto.2019.102370.
19. Patow CA, Norton JA, Brennan MF. Vocal cord paralysis and reoperative parathyroidectomy. A prospective study. Ann Surg, 1986, 203(3): 282-285.
20. Nafisi-Moghadam R, Amlelshahbaz AP, Namiranian N, et al. comparative diagnostic performance of ultrasonography and ^99mTc-sestamibi scintigraphy for parathyroid adenoma in primary hyperparathyroidism; systematic review and meta-analysis. Asian Pac J Cancer Prev, 2017, 18(12): 3195-3200.
21. Noda S, Onoda N, Kashiwagi S, et al. Strategy of operative treatment of hyperparathyroidism using US scan and^99mTc-MIBI SPECT/CT. Endocr J, 2014, 61(3): 225-230.
22. Medas F, Cappellacci F, Canu GL, et al. The role of Rapid Intraoperative Parathyroid Hormone (ioPTH) assay in determining outcome of parathyroidectomy in primary hyperparathyroidism: a systematic review and meta-analysis. Int J Surg, 2021, 92: 106042. doi: 10.1016/j.ijsu.2021.106042.
23. Isaacs KE, Belete S, Miller BJ, et al. Video-assisted thoracoscopic surgery for ectopic mediastinal parathyroid adenoma. BJS Open, 2019, 3(6): 743-749.
24. Du H, Shi M, Zhu L, et al. Comparison of video-assisted thoracic surgery with open surgery in the treatment of ectopic mediastinal parathyroid tumors. J Thorac Dis, 2017, 9(12): 5171-5175.

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纵隔内异位甲状旁腺功能亢进症的诊治体会：附3例报道

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