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Primer hiperparatiroidizm cerrahisinde başarıyı artıran faktörler

Year 2020, Volume: 11 Issue: 4, 232 - 236, 30.09.2020
https://doi.org/10.18663/tjcl.641304

Abstract

Amaç: Primer hiperparatiroidizm hastalarında son yıllarda standart bilateral boyun eksplorasyonu yerine, seçilmiş hastalarda minimal insizyon ile paratiroidektomi tercih edilmeye başlanmıştır. Hangi grup hastaya minimal insizyonun uygun olduğunu tespit etmek için bazı çalışmalar yapılmış ve bunlara dayanarak bir takım indeksler önerilmiştir. Bizde bu çalışmada kendi klinik olgularımızda bu parametrelerin geçerliliğini değerlendirmek amacıyla bu çalışmayı planladık.

Gereç ve Yöntemler: Çalışmamızda Ocak 2009-2016 tarihleri arasında Okmeydanı Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniğinde Primer hiperparatiroidizm tanısıyla ameliyat edilmiş hastaların dosyaları retrospektif olarak incelenip sonuçlar istatistiksel olarak değerlendirildi.

Bulgular: Primer hiperparatiroidi tanısı ile ameliyat olan 166 hasta çalışmaya alındı. Bu hastaların 14’ünün çoklu bez hastalığı olduğu görüldü. Tekli bez ile çoklu bez hastaları arasında yaş ve cinsiyet açısından istatistiksel olarak fark olmadığı saptandı. Çoklu bez hastalarında piyes boyutu ve ağırlığının istatistiksel olarak daha düşük olduğu gözlendi. Ameliyat öncesi ve sonrası kalsiyum ile parathormon(Pth) değerlerinde ise bir fark olmadığı gözlendi. Minimal invazif paratiroidektomi(MIP) ya da bilateral boyun eksplorasyonu ile paratiroidektomi yapılan hastalar istatistiksel olarak karşılaştırılarak gruplar arası fark olmadığı gözlendi. Mevcut parametreler önerilen indekslere uygulandı.

Sonuç: Primer hiperparatiroidizm hastalarında tekli bez ve çoklu bez hastalığı ayrımı için biyokimyasal parametreler ile görüntüleme yöntemlerinin korelasyonuna dayalı skorlama sistemleri öneren çalışmalar mevcuttur. Bu skorlama sistemlerinin ve değerlendirme parametrelerinin etkinliği bizim hastalarımızda değerlendirildi. Bizim hastalarımızda CaPTHUS skorlama sisteminin faydalı olduğu tespit edilirken, Wisconsin indeksi ise hasta sayısının azlığından dolayı istatistiksel olarak az bir farkla anlamlandırılamamıştır. Bu yüzden tekli bez ve çoklu bez hastalığı ayrımını kolaylaştırmak için daha geniş ve prospektif çalışmaların gerekliliği söz konusudur. Minimal insizyon ile bilateral boyun eksplorasyonu karşılaştırmasında, şeçilmiş hastalarda MIP için güvenilir olduğu belirlenmiştir.

References

  • 1. Walker MD, Silverberg SJ. Primary hyperparathyrodism. Nat Rev Endocrinol 2018; 14: 115-25.
  • 2. Cope O. The Study Of Hyperparathyroidsm At The Massachusetts General Hospital. N Engl J Med 1966; 274: 1174.
  • 3. Stevens JC. Lateral Approach For Exploration Of The Parathyroid Gland. Surg Gynecol Obstet 1979; 148: 431.
  • 4. Norman J, Chheda H. Minimally Invasive Parathyroidectomy Facilitated By Intraoperative Nuclear Mapping. Surgery 1997; 122: 998-1004.
  • 5. Kebebew E, Hwang J, Reiff E, Duh QY, Clark OH. Predictors of single-gland vs multigland parathyroid disease in primary hyperparathyroidism: a simple and accurate scoring model. Arch Surg 2006; 141: 777– 82.
  • 6. Mazeh H, Chen H, Leverson G, Sippel RS. Creation of a “Wisconsin index” nomogram to predict the likelihood of additional hyperfunctioning parathyroid glands during parathyroidectomy. Ann Surg 2013; 257: 138–41
  • 7. John H. Yim, Gerard M. Doherty. Section 12 Operative Strategies in Primary Hiperparathyroidisim. Surgical Endocrinology, Lippincott Williams and Wilkins, Philadelphia; 2001.
  • 8. Sheldon DG, Lee FT, Neil NJ, Ryan JA. Surgical treatment of hyperparathyroidism improves health-related quality of life. Arch Surg 2002; 137: 1022-8.
  • 9. Palazzo F, Sadler GP. Minimally invasive parathyroidectomy, heralds a new era in the treatment of primary hyperparathyroidism. BMJ 2004; 328: 849-50.
  • 10. Kukar M, Platz TA, Schaffner TJ et al. The use of modified fourdimensional computed tomography in patients with primary hyperparathyroidism: an argument for the abandonment of routine sestamibi single-positron emission computed tomography (SPECT). Ann Surg Oncol 2015; 22: 139–45
  • 11. Kotan Ç, Sümer A, Öztürk ve ark. Primer hiperparatroidi: Van deneyimi, 149 Olgunun Değerlendirilmesi. Endokrinolojide Diyalog 2008; 2: 27-32.
  • 12. Kearns AE, Thompson GB. Medical and surgical management of hyperparathyroidism. Mayo Clin Proc 2002; 77: 87-91.
  • 13. van Dalen A, Smit CP, van Vroonhoven TJ, Burger H, de Lange EE. Minimally invasive surgery for solitary parathyroid adenoma in patients with primary hyperparathyroidism: role of US with supplemental CT. Radiology 2001; 220: 631-9.
  • 14. Udelsman R, Pasieka JL, Sturgeon C, Young JE, Clark OH. Surgery for asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab 2009; 94: 366-72.
  • 15. Quiros RM, Alioto J, Wilhelm SM, Ali A, Prinz RA. An algorithm to maximize use of minimally invasive parathyroidectomy. Arch Surg 2004; 139: 501-6.

Factors increasing surgery success in primary hyperparathyroidism

Year 2020, Volume: 11 Issue: 4, 232 - 236, 30.09.2020
https://doi.org/10.18663/tjcl.641304

Abstract

Aim: Standart procedure for Primary hyperparathyroidism patients’ is two sides neck exploration, during the last years minimal incision started to be used for primary hyperparathyroidisim patients at primary hyperparathyrodism patients. Some researchers had been done to which patients should perform minimal incision surgery that a set of indexes proposed to use. So we can try to show which parameters should be use for get better surgery results.

Material and Methods: Files of the patients, that undergo surgery for primary parathyroidism between January 2009-2016, will be studied retrospectively.

Results: There 166 patients operated for primary hyperparathyroidism. 14 of these patients have multi gland disease. There is no difference for single gland disease and multigland disease patients between age and gender statistically. Multiglands disease patients’ pathology specimens lenght and weight is lower than single gland disease group statistically. Preoperative and post operative parathormone(Pth) and calcium levels have no statistical difference. Comparing minimal invasive parathyroidectomy(MIP) and bilateral neck exploration parathyroidectomy shows there is no statistically difference between them. Avaible parameters applied advised parameters.

Conclusion: There is scoring systems, that made from combination of biochemical parameters and screening methods, seperate single gland disease and multiple glands disease. We evaluated these scoring system among our patients. CaPTHUS scoring system seems useful at our patient group. Wisconsin index is statisticaly meaningless with slight difference. So there is need to more crowded and prospective studies to be done for seperating multi gland disease and solitary adenoma. Comparing Minimal invasive parathyroidectomy and bilateral neck exploration parathyroidectomy shows that MIP is a safe procedure in selected patients. 

References

  • 1. Walker MD, Silverberg SJ. Primary hyperparathyrodism. Nat Rev Endocrinol 2018; 14: 115-25.
  • 2. Cope O. The Study Of Hyperparathyroidsm At The Massachusetts General Hospital. N Engl J Med 1966; 274: 1174.
  • 3. Stevens JC. Lateral Approach For Exploration Of The Parathyroid Gland. Surg Gynecol Obstet 1979; 148: 431.
  • 4. Norman J, Chheda H. Minimally Invasive Parathyroidectomy Facilitated By Intraoperative Nuclear Mapping. Surgery 1997; 122: 998-1004.
  • 5. Kebebew E, Hwang J, Reiff E, Duh QY, Clark OH. Predictors of single-gland vs multigland parathyroid disease in primary hyperparathyroidism: a simple and accurate scoring model. Arch Surg 2006; 141: 777– 82.
  • 6. Mazeh H, Chen H, Leverson G, Sippel RS. Creation of a “Wisconsin index” nomogram to predict the likelihood of additional hyperfunctioning parathyroid glands during parathyroidectomy. Ann Surg 2013; 257: 138–41
  • 7. John H. Yim, Gerard M. Doherty. Section 12 Operative Strategies in Primary Hiperparathyroidisim. Surgical Endocrinology, Lippincott Williams and Wilkins, Philadelphia; 2001.
  • 8. Sheldon DG, Lee FT, Neil NJ, Ryan JA. Surgical treatment of hyperparathyroidism improves health-related quality of life. Arch Surg 2002; 137: 1022-8.
  • 9. Palazzo F, Sadler GP. Minimally invasive parathyroidectomy, heralds a new era in the treatment of primary hyperparathyroidism. BMJ 2004; 328: 849-50.
  • 10. Kukar M, Platz TA, Schaffner TJ et al. The use of modified fourdimensional computed tomography in patients with primary hyperparathyroidism: an argument for the abandonment of routine sestamibi single-positron emission computed tomography (SPECT). Ann Surg Oncol 2015; 22: 139–45
  • 11. Kotan Ç, Sümer A, Öztürk ve ark. Primer hiperparatroidi: Van deneyimi, 149 Olgunun Değerlendirilmesi. Endokrinolojide Diyalog 2008; 2: 27-32.
  • 12. Kearns AE, Thompson GB. Medical and surgical management of hyperparathyroidism. Mayo Clin Proc 2002; 77: 87-91.
  • 13. van Dalen A, Smit CP, van Vroonhoven TJ, Burger H, de Lange EE. Minimally invasive surgery for solitary parathyroid adenoma in patients with primary hyperparathyroidism: role of US with supplemental CT. Radiology 2001; 220: 631-9.
  • 14. Udelsman R, Pasieka JL, Sturgeon C, Young JE, Clark OH. Surgery for asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab 2009; 94: 366-72.
  • 15. Quiros RM, Alioto J, Wilhelm SM, Ali A, Prinz RA. An algorithm to maximize use of minimally invasive parathyroidectomy. Arch Surg 2004; 139: 501-6.
There are 15 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Orıgınal Artıcle
Authors

Ahmet Cem Esmer 0000-0001-8279-186X

Orhan Yalçın This is me 0000-0002-7933-8201

Arzu Akan 0000-0001-8435-9771

Deniz Tazeoğlu 0000-0002-5947-8653

Publication Date September 30, 2020
Published in Issue Year 2020 Volume: 11 Issue: 4

Cite

APA Esmer, A. C., Yalçın, O., Akan, A., Tazeoğlu, D. (2020). Factors increasing surgery success in primary hyperparathyroidism. Turkish Journal of Clinics and Laboratory, 11(4), 232-236. https://doi.org/10.18663/tjcl.641304
AMA Esmer AC, Yalçın O, Akan A, Tazeoğlu D. Factors increasing surgery success in primary hyperparathyroidism. TJCL. September 2020;11(4):232-236. doi:10.18663/tjcl.641304
Chicago Esmer, Ahmet Cem, Orhan Yalçın, Arzu Akan, and Deniz Tazeoğlu. “Factors Increasing Surgery Success in Primary Hyperparathyroidism”. Turkish Journal of Clinics and Laboratory 11, no. 4 (September 2020): 232-36. https://doi.org/10.18663/tjcl.641304.
EndNote Esmer AC, Yalçın O, Akan A, Tazeoğlu D (September 1, 2020) Factors increasing surgery success in primary hyperparathyroidism. Turkish Journal of Clinics and Laboratory 11 4 232–236.
IEEE A. C. Esmer, O. Yalçın, A. Akan, and D. Tazeoğlu, “Factors increasing surgery success in primary hyperparathyroidism”, TJCL, vol. 11, no. 4, pp. 232–236, 2020, doi: 10.18663/tjcl.641304.
ISNAD Esmer, Ahmet Cem et al. “Factors Increasing Surgery Success in Primary Hyperparathyroidism”. Turkish Journal of Clinics and Laboratory 11/4 (September 2020), 232-236. https://doi.org/10.18663/tjcl.641304.
JAMA Esmer AC, Yalçın O, Akan A, Tazeoğlu D. Factors increasing surgery success in primary hyperparathyroidism. TJCL. 2020;11:232–236.
MLA Esmer, Ahmet Cem et al. “Factors Increasing Surgery Success in Primary Hyperparathyroidism”. Turkish Journal of Clinics and Laboratory, vol. 11, no. 4, 2020, pp. 232-6, doi:10.18663/tjcl.641304.
Vancouver Esmer AC, Yalçın O, Akan A, Tazeoğlu D. Factors increasing surgery success in primary hyperparathyroidism. TJCL. 2020;11(4):232-6.


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