Clinical Investigation of Surgical Treatment in Patients with Primary Hyperparathyroidism

Abstract

We herein review the clinico-pathological features of 36 patients who received surgery for primary hyperparathyroidism in our hospital between October 1997 and August 2010. Among the 36 cases, there were 8 males and 28 females with ages ranging from 21 to 79 yr (average: 56.1 yr). In a retrospective review, we studied the presenting symptoms, results of the blood examination including serum ionized calcium and intact-PTH, preoperative diagnosis of localization, operation method, histopathologic diagnosis, results of surgery and any complications. From the 36 cases we reviewed, 23 cases (63.8%) were asymptomatic and hypercalcemia was detected. The values of preoperative serum calcium and intact-PTH were high in all cases. Cervical echography, CT, MRI, and 99mTc-MIBI scintigraphy were performed as the preoperative imaging, and a high probability diagnosis of the location of the tumor was possible. As for the surgical approach, a unilateral parathyroidectomy was performed in all patients. The postoperative pathological diagnosis in all cases was a benign lesion, with the majority (66.7%) comprising adenomas. After the surgery, the values of postoperative serum calcium and intact-PTH were normalized in almost all cases, but recurrences were found in two cases. No laryngeal nerve injury was seen as a postoperative complication. The appropriate surgical approach has conventionally been determined by a histopathological diagnosis, but we have determined the surgical approach by the number of tumescent glandular lesions and the localization of the tumor. It is necessary to choose an appropriate surgical approach prior to the operation to avoid the risk of postoperative recurrence and complications.