Experiences in gamma probe-guided minimally invasive parathyroidectomy
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Tarih
2012
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Primer hiperparatiroidizmin %8090 nedeni tek bezde görülen paratiroid adenomudur. Son yıllarda ultrasonografi, Tc 99 M sesta MIBI ve gama prob gibi paratiroidleri lokalize edici tekniklerin kullanılması ile primer hiperparatiroidi tedavisinde minimal invaziv paratiroidektomi (MIP) başarıyla uygulanmaya başlanmıştır. Bu çalışmada son 4 yılda Selçuk Üniversitesi Meram Tıp Fakültesi Genel Cerrahi Kliniğinde primer hiperparatiroidi nedeniyle gama prob eşliğinde işaretleme ile minimal invaziv paratiroidektomi yapılan 14 hastanın analizi ve klinik özellikleri değerlendirildi. Hastalardan 10u kadın, 4ü erkek ve yaş ortalamaları 54,6 (39-74) idi. Operasyon öncesi ortalama Ca seviyeleri 11,7 mg/dl (10,1 13,3, normali: 8,9-10,3), fosfor seviyeleri 2,7 mg/dl (1,6-3,9, normali: 2,4-4,7) ve PTH 260,3 pg/ml (74,94 - 990,8 normali: 12-88) olarak ölçüldü. Hastaların kliniğimize başvuru şikâyetleri arasında baş ağrısı ve yaygın kemik ağrısı ön plandaydı. Tüm hastalara lokal anestezi ile birlikte sedasyon uygulandı. Sınırlı flep diseksiyonundan sonra strep kasları vertikal olarak açılarak adenoma ulaşıldı. Vasküler yapıları bipolar koter eşliğinde kesildi ve kapsülü zedelenmeden adenom çıkarıldı. Post operatif dönemde hastaların hastanede kalış süresi ort. 1,5 (1 ile 3 gün) gündü. Ortalama Ca seviyeleri 9,1 mg/dl, fosfor seviyeleri 3,2 mg/dl ve PTH ise 63,8 pg/ml olarak ölçüldü. Gama prob eşliğinde minimal invaziv paratiroidektomi; operasyonunun lokal anestezi ile yapılabilmesi, operasyon sonrası ağrının daha az olması ve düşük komplikasyon oranı ile günümüzde paratiroid cerrahisinde sık tercih edilen yöntemlerdendir.
Parathyroid adenoma seen in a single gland comprises 80-90% of the reasons for primary hyperparathyroidism. The recent use of parathyroid localizing techniques such as ultrasonography, Tc 99 M sesta MIBI, and gamma probe has made minimally invasive parathyroidectomy (MIP) a success in hyperparathyroidism therapy. This study evaluates the analyses and clinical characteristics of 14 patients with primary hyperparathyroidism who have undergone minimally invasive parathyroidectomy by gamma probe marking at Selçuk University, Meram Faculty of Medicine, General Surgery Clinic in the last four years. Ten of the patients were female while four were male, with a mean age of 54.6 (39-74). The patients preoperative mean Ca levels were 11.7 mg/dl (10.1 13.3, normal: 8.9-10.3), phosphorous levels were 2.7 mg/dl (1.6-3.9, normal: 2.4-4.7), and PTH levels were 260,3 pg/ml (74.94 990.8 normal: 12-88). Among the complaints the patients had when they presented to our clinic, headache and generalized bone pain were predominant. All the patients were sedated with local anesthesia. Following a bordered flap dissection the adenoma was reached through the vertical opening of the strap muscles. The vascular structures were cut by bipolar cautery and the adenoma was removed with no damage to its capsule. The mean period of hospitalization was 1.5 days (1 to 3 days) during the postoperative period. The patients postoperative mean Ca levels were 9.1 mg/dl while the levels of phosphorus and PTH were 3.2 mg/dl and 63.8 mg/dl respectively. Minimally invasive parathyroidectomy with a gamma probe is one of the most frequently used techniques in parathyroid surgery today because the procedure can be performed with local anesthesia, there is less postoperative pain, and a lower rate of complications.
Parathyroid adenoma seen in a single gland comprises 80-90% of the reasons for primary hyperparathyroidism. The recent use of parathyroid localizing techniques such as ultrasonography, Tc 99 M sesta MIBI, and gamma probe has made minimally invasive parathyroidectomy (MIP) a success in hyperparathyroidism therapy. This study evaluates the analyses and clinical characteristics of 14 patients with primary hyperparathyroidism who have undergone minimally invasive parathyroidectomy by gamma probe marking at Selçuk University, Meram Faculty of Medicine, General Surgery Clinic in the last four years. Ten of the patients were female while four were male, with a mean age of 54.6 (39-74). The patients preoperative mean Ca levels were 11.7 mg/dl (10.1 13.3, normal: 8.9-10.3), phosphorous levels were 2.7 mg/dl (1.6-3.9, normal: 2.4-4.7), and PTH levels were 260,3 pg/ml (74.94 990.8 normal: 12-88). Among the complaints the patients had when they presented to our clinic, headache and generalized bone pain were predominant. All the patients were sedated with local anesthesia. Following a bordered flap dissection the adenoma was reached through the vertical opening of the strap muscles. The vascular structures were cut by bipolar cautery and the adenoma was removed with no damage to its capsule. The mean period of hospitalization was 1.5 days (1 to 3 days) during the postoperative period. The patients postoperative mean Ca levels were 9.1 mg/dl while the levels of phosphorus and PTH were 3.2 mg/dl and 63.8 mg/dl respectively. Minimally invasive parathyroidectomy with a gamma probe is one of the most frequently used techniques in parathyroid surgery today because the procedure can be performed with local anesthesia, there is less postoperative pain, and a lower rate of complications.
Açıklama
Anahtar Kelimeler
Endokrinoloji ve Metabolizma
Kaynak
Endokrinolojide Diyalog Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
9
Sayı
3
