Online Makale
Online Hizmetlere Toplu BakışSisli Etfal Tip Bülteni
Med Bull Sisli Etfal Hosp. 2019; 53(4): 337-352 | DOI: 10.14744/SEMB.2019.67944 | |||
Primer Hiperparatiroidizmin Cerrahi Tedavisinde Temel Cerrahi İlkeler Ve Cerrahi YöntemlerMehmet Uludag1, Nurcihan Aygun1, Adnan Isgor21Department of Genaral Surgery, Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey2Department of Genaral Surgery, Bahcesehir University, Faculty of Medicine, Istanbul, Turkey Primer hiperparatiroidizm (pHPT)’in tek küratif tedavisi cerrahidir. Paratiroidektomide başarı oranını arttıran en önemli faktörler; tanının doğru konulması ve cerrahın iyi anatomi ve embriyo-loji bilgisine sahip olmasıdır. Main Surgical Principles and Methods in Surgical Treatment of Primary HyperparathyroidismMehmet Uludag1, Nurcihan Aygun1, Adnan Isgor21Department of Genaral Surgery, Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey2Department of Genaral Surgery, Bahcesehir University, Faculty of Medicine, Istanbul, Turkey The only curative treatment for primary hyperparathyroidism (pHPT) is surgery. The most important factors that increase the success rate of a parathyroidectomy are the establishment of the correct diagnosis and the surgeon’s good knowledge of anatomy and embryology. The lower parathyroid glands develop from the dorsal portion of the third pharyngeal pouch, and the upper parathyroid glands from the fourth pharyngeal pouch. Humans typically have 4 parathyroid glands; however, more than 4 and fewer than 4 have been observed. Typically, the upper parathyroid glands are located in the cricothyroid junction area on the posterolateral portion of the middle and upper third of the thyroid, while the lower parathyroids are located in an area 1 cm in diameter located posterior, lateral, or anterolateral to the lower thyroid pole. Ectopic locations of parathyroid glands outside the normal anatomical regions due to the abnormal migration during embryological development or acquired ectopy due to migration of enlarged parathyroids are not uncommon. There are various surgical techniques to treat HPT; however, 2 main surgical options are used: bilateral neck exploration (BNE) and minimally invasive parathyroidectomy (MIP). While there are open, endoscopic, and video-assisted MIP (MIVAP) approaches, most often an open lateral MIP technique is used. In addition, endoscopic or robotic parathyroidectomy methods performed from remote regions outside the neck have been reported. Although currently MIP is the standard treatment option in selected patients with positive imaging, BNE remains the gold standard procedure in parathyroid surgery. In 80% to 90% of patients with pHPT, a pathological parathyroid gland can be detected with preoperative imaging methods and MIP can be applied. However, the pathological gland may not be found during a MIP procedure as a result of false positive results. The parathyroid surgeon must also know the BNE technique and be able to switch to BNE and change the surgical strategy if necessary. If the intended gland is not found in its normal anatomical site, possible embryological and acquired ectopic locations should be investigated. It should be kept in mind that MIP and BNE are not alternatives to each other, but rather complementary techniques for successful treatment in parathyroid surgery. Keywords: Bilateral neck exploration, minimal invasive parathyroidectomy; primary hyperparathyroidism; surgical techniques.Mehmet Uludag, Nurcihan Aygun, Adnan Isgor. Main Surgical Principles and Methods in Surgical Treatment of Primary Hyperparathyroidism. Med Bull Sisli Etfal Hosp. 2019; 53(4): 337-352 Sorumlu Yazar: Nurcihan Aygun |
|