SURGICAL TREATMENT OF PERSISTENT HYPERPARATHYROIDISM
Abstract
Introduction. Persistent or recurrent primary hyperparathyroidism (PHPT) is detected in 3.4–6.5 % and is an unsatisfactory outcome of the operation to remove parathyroid tumors. Persistence is diagnosed when hypercalcemia appears up to 6 months after surgery. If it occurs at a later date, hyperparathyroidism is considered to be recurrent. Persistent or recurrent forms of PHPT usually requirerepeated operation, although determination of indications should be individualized. Materials and methods. There were 546 patients with PHPT aged from 6 to 82 years were operated on during the period from 1973 to 2022 on in our clinic. All the patients underwent bilateral revision of the neck, removal of parathyroid tumors. Persistence of PHPT was diagnosed in 9 (1.6 %) patients. Results and discussion. Persistent hypercalcemia and an increase in the level of parathyroid hormone were detected in the period from 1 to 6 month after the initial operation in all 9 patients. The level of total calcium was 2.65–3.55 mmol/l. Three patients with mild hypercalcemia and absence of clinical symptoms had negative ultrasound and SPECTCT results. These patients are left for observation. One patient refused examination and further treatment. Repeated surgical interventions for persistent PHPT were performed in 5 patients. The study analyzes the main predisposing factors of persistence at the diagnostic and operational stages. Revision errors during the primary surgery were found in 3 patients and in 2 cases — by the retrosternal location of the tumor. Conclusions. The main reasons for the persistence of hyperparathyroidism are the inadequate volume of the primary operation and ectopic parathyroid adenoma in the mediastinum. The use of high-tech research methods (SPECT-CT and MSCT) in a difficult diagnostic situation makes it possible to perform an accurate topical diagnosis of ectopic adenoma and choose the optimal method of surgical intervention. Use of the da Vinci robotic system made it possible to remove mediastinal adenoma with minimal surgical trauma.
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