[Surgery of primary hyperparathyroidism by unilateral approach under local anesthesia and intraoperative determination of PTH 1-84].
Between July 89 and June 92, 70 patients with primary hyperparathyroidism underwent adenomectomy by unilateral incision under local anesthesia (Ul/LA), without exploration of the remaining glands. The procedure was carried out with intraoperative monitoring of urinary cyclic AMP (n = 35), Calcemia was measured 6-monthly for one year in every patient. 62 (88.6%) patients were cured after Ul/LA, whereas 5 patients required conversion to bilateral cervicotomy under general anesthesia because of abnormal hormonal levels, thus giving an overall success rate of 97% (67/70). The reasons for treatment failure of Ul/LA included misleading conclusions of cervical ultrasonography (n = 5), agitation of the patient (n = 1) and deep localization of the adenoma (n = 1). When cervical ultrasonography is suggestive of a parathyroid adenoma in expert hands, the probability of a second localization or associated hyperplasia is very low, so that adenomectomy by Ul/LA can be attempted safely, provided that the serum level of intact parathyroid hormone returns to normal values within one hour following resection. In our experience, parathyroidectomy by Ul/LA should not be considered in case of non conclusive ultrasonography, familial history pf hyperparathyroidism of MEN-I, ultrasonic evidence of several enlarged glands or associated thyroid nodule requiring simultaneous treatment.
Clinique Chirurgicale, Hôpital Cochin, Paris.
Y
Y
Chapuis
B
B
Richard
Y
Y
Fulla
P
P
Bonnichon
E
E
Tarla
P
P
Icard
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D000242:Cyclic AMP / Q000652:urine; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000601:surgery*; D007432:Intraoperative Period; D008297:Male; D008722:Methods; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*
D010281:Parathyroid Hormone; D000242:Cyclic AMP
Chirurgie de l'hyperparathyroïdie primaire par abord unilatéral sous anesthésie locale et dosage per-opératoire de la PTH 1-84.