Chirurgická léčba hyperparatyreózy

Sugical Treatment ofHyperparathyroidism

The authors present their own experience with the surgical treatment of hyperparathyroidism. In the course of five years - from the beginning of 1996 to the end of 2000 they p erformed49 operations on account of hyperparathyroidism in 48 subjects. The patients’ age was within the range of 17-76 years with an average of 53 years. Women predominated over men, the ratio being4:1. Three patients were recommended for surgery by an endocrinologist, or a nephrologist in caseof tertiary hyperparathyroidism (hyperplasia of all parathyroid bodies), in the remaining 45subjects primary hyperparathyroidism was involved. As to imaging methods, before surgery mostfrequently ultrasound was used - in 100% (sensitivity 90%), the second most frequently usedexamination was scintigraphy (MBI scan) with a sensitivity of 88%. In 45% patients with adenomaof the parathyroid unilateral revision with removal of an adenoma was performed or removal ofanother ipsilateral body. In three patients with tertiary hyperparathyroidism and hyperplasia ofall bodies the authors selected subtotal parathyroidectomy with preservation of one body, ora complete procedure with implantation of one body into the musculature of the forearm. In caseof nodular reconstruction of the thyroid gland surgery was combined with an appropriate operationof the thyroid gland (most frequently lobectomy on the side of the adenoma of the parathyroid body).Complete cure of hyperparathyroidism (elimination of clinical and laboratory signs of hypercalcaemia) was achieved in 45 patients (94%). Reoperation was necessary in one instance in a femalepatient with a multiple adenoma of the parathyroid gland. In three patients (6%) hypercalcaemiapersists also after surgery. As to possible complications the authors recorded temporary paresis ofthe recurrent nerve in four patients (8%). Permanent paresis of the recurrent nerve developed intwo patients (4%). In one female patient with a paraoesophageal localization of an adenoma of theparathyroid gland during operation perforation of the oesophagus occurred. The authors payattention to the anatomy and pathology of the parathroid glands, discuss views on the indicationand technique of surgical treatment of hyperparathyroidism.

Key words:
hypercalcaemia, hyperparathyroidism, surgical treatment.