Abstract
Thirty-three patients underwent median sternotomy at reoperation for persistent or recurrent hyperparathyroidism. Radiographic studies correctly localized abnormal tissue to the mediastinum in 21 patients and surgery was successful in 19 of them. In the 12 patients without preoperative localization, surgery was successful in 9. Twenty-six of 29 patients with a diagnosis of parathyroid adenoma had successful surgery, while only 2 of 4 patients with hyperplasia had successful procedures. In 10 patients the median sternotomy proved unnecessary since the parathyroid abnormality was located at a site reachable through the cervical incision. Abnormal parathyroid glands were found in the thymus (21), posterior to the thymus along the arch (6), within the thyroid (4), and at other ectopic locations. Abnormal parathyroid glands found within the thymus were often smaller than 1 cm in diameter and were detected by the pathologist after dissecting the entire thymus, indicating the need for total thymectomy. The complication rate was 12%, and the mortality rate was 6%.
Résumé
Trente-trois sujets ont subi une sternotomie médiane lors de réinterventions pour hyperparathyroïdisme persistant ou récidivant. L'exploration radiologique avait permis de localiser correctement le tissu anormal au niveau du médiastin chez 21 patients et la chirurgie fut suivie de succès chez 19 d'entre eux. Chez 12 malades chez qui le siège de la tumeur n'avait pu être défini, l'intervention permis de découvrir et de traiter avec succès 9 d'entre eux. Vingt-six des 29 malades qui présentaient un adénome parathyroïdien furent guéris alors que seulement 2 sur 4 des sujets qui étaient porteurs d'une hyperplasie parathyroïdienne furent traités avec succès. La sternotomie pour pratiquer l'exérèse du tissu parathyroïdien anormal s'est montrée nécessaire dans seulement 70% des cas. Le tissu anormal fut découvert dans le thymus (21), derrière le thymus (6), dans la thyroïde (4) ou ailleurs. Les glandes parathyroïdes incluses dans le thymus étaient d'un diamètre inférieur à 1 cm et ne furent découvertes que par l'anatomo-pathologiste, ce fait plaidant en faveur de la thymectomie totale lorsque les glandes restantes ne sont pas découvertes par l'exploration complète. Les taux respectifs des complications et de la mortalité furent de 12% et de 6%.
Resumen
Treinta y tres pacientes fueron sometidos a esternotomía mediana para reoperación por hiperparatiroidismo persistente o recurrente. Los estudios radiológicos localizaron en forma correcta el tejido anormal en el mediastino en 21 pacientes, y la cirugía fué exitosa en 19 de ellos. En los 12 pacientes sin localización preoperatoria la cirugía fué exitosa en 9. Veintiseis de 29 pacientes con diagnóstico de adenoma paratiroideo fueron operados exitosamente, mientras sólo 2 de 4 pacientes con hiperplasia tuvieron operaciones exitosas. La esternotomía fué necesaria para la resección de tejido paratiroideo anormal en sólo 70% de los pacientes. Glándulas paratiroides anormales fueron halladas en el timo (21), sobre el arco aórtico y posterior al timo (6), en la glándula tiroides (4) y en otras ubicaciones ectópicas. Los paratiroides anormalmente presentes en el timo generalmente fueron de menos de 1 cm de diámetro y fueron halladas por el patólogo sólo después de disecar la totalidad del timo, lo cual señala la necesidad de realizar timectomía total. La tasa de complicaciones fué de 12% y la de mortalidad de 6%.
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References
Mundy, G.R., Cove, D.H., Fisken, R.: Primary hyperparathyroidism: Changes in the pattern of clinical presentation. Lancet1:1317, 1980
Wells, S.A., Jr., Leight, G.S., Ross, A.J.: Primary hyperparathyroidism. Curr. Probl. Surg.17:398, 1980
Beazley, R.M., Costa, J., Ketcham, A.S.: Reoperative parathyroid surgery. Am. J. Surg.130:427, 1975
Van Vroonhoven, T.J., Muller, H.: Causes of failure in the surgical treatment of primary hyperparathyroidism: Lessons from 51 successful reoperations. Br. J. Surg.65:297, 1978
Wang, C.A.: The anatomic basis of parathyroid surgery. Ann. Surg.183:271, 1976
Akerstrom, G., Malmaeus, J., Bergstrom, R.: Surgical anatomy of human parathyroid glands. Surgery95:14, 1984
Edis, A.J., Sheedy, P.F., Beahrs, O.H., van Heerden, J.A.: Results of reoperation for hyperparathyroidism, with evaluation of preoperative localization studies. Surgery84:384, 1978
Wang, C.A.: Parathyroid re-exploration. Ann. Surg.186:140, 1977
Brennan, M.F., Marx, S.J., Doppman, J., Costa, J., Saxe, A., Spiegel, A., Krudy, A., Aurbach, G.: Results of reoperation for persistent and recurrent hyperparathyroidism. Ann. Surg.194:671, 1981
Brennan, M.F., Norton, J.A.: Reoperation for persistent and recurrent hyperparathyroidism. Ann. Surg.201: 40, 1985
Norton, J.A., Brennan, M.F., Saxe, A.W., Wesley, R.A., Doppman, J.L., Krudy, A.G., Marx, S.J., Santora, A.C., Hicks, M., Aurbach, G.D., Spiegel, A.M.: Intraoperative urinary cyclic adenosine monophosphate as a guide to successful reoperative parathyroidectomy. Ann. Surg.200: 389, 1984
Doppman, J.L., Marx, S.J., Brennan, M.F., Beazley, R.H., Geelhoed, G., Aurbach, G.D., Motk, H.: The blood supply of mediastinal parathyroid adenomas. Ann. Surg.185:488, 1977
Geelhoed, G.W., Krudy, A.G., Doppman, J.L.: Long-term follow-up of patients with hyperparathyroidism treated by transcatheter staining with contrast agent. Surgery94:849, 1983
Niederle, B., Roka, R., Brennan, M.F.: The transplantation of parathyroid tissue in man: Development, indications, technique, and results. Endocr. Rev.3:245, 1982
Scholz, D.A., Purnell, D.C., Woolner, L.B., Clagett, O.T.: Mediastinal hyperfunctioning parathyroid tumors: Review of 14 cases. Ann. Surg.178:173, 1973
Wang, C.A., Mahaffey, J.E., Axelrod, L., Perlman, J.A.: Hyperfunctioning supernumary parathyroid glands. Surg. Gynecol. Obstet.148:711, 1979
Thompson, N.W., Eckhauser, F.E., Harness, J.K.: The anatomy of primary hyperparathyroidism. Surgery92:815, 1982
Krudy, A.G., Doppman, J.L., Brennan, M.F., Marx, S.J., Spiegel, A.M., Stock, J.L., Aurbach, G.D.: The detection of mediastinal parathyroid glands by computed tomography, selective arteriography and venous sampling. Radiology140:739, 1981
Gilmour, J.R.: Embryology of the parathyroid glands, thymus and certain associated rudiments. J. Pathol. Bacteriol.45:507, 1937
Saxe, A.W., Brennan, M.F.: Reoperative parathyroid surgery for primary hyperparathyroidism caused by multiple-gland disease: Total parathyroidectomy and autotransplantation with cryopreserved tissue. Surgery91:616, 1982
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Norton, J.A., Schneider, P.D. & Brennan, M.F. Median sternotomy in reoperations for primary hyperparathyroidism. World J. Surg. 9, 807–812 (1985). https://doi.org/10.1007/BF01655200
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DOI: https://doi.org/10.1007/BF01655200