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Operative strategie bei persistenz und rezidiv in der chirurgie des primären hyperparathyreoidismus

Operative strategy in persisting and recurrent primary hyperparathyroidism

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Abstract

Persisting hypercalcemia after surgery for primary hyperparathyroidism is a challenge for the surgeon: once non-parathyroid causes for the hypercalcemia have been excluded the only remaining possible causes are ineffective surgery and a failed surgery. Between 1986 and 1994, 414 patients with primary hyperparathyroidism were operated upon, 32 of whom presented with persisting hypercalcemia; 24 of these patients had their first operation in another hospital. The cause for persisting hypercalcemia was a single adenoma in 27 patients (84%), double adenoma in 2 patients and primary hyperplasia in 2 patients. In 1 patient an unsuccessful revision operation was performed. In 17 patients the parathyroid glands had an atypical position. There were 11 patients who presented with recurrent hyperplasia. The reasons for recurrence were double adenoma in 2 patients and hyperplasia in 8 cases (73 %). In 1 patient no pathologic gland was found. Although preoperative localization studies were positive in only 32%, the overall surgical success rate fortunately amounted to a satisfactory 95%.

Zusammenfassung

Eine persistierende Hyperkalzämie nach Hyperparathyreoidismusoperation stellt den Chirurgen vor ein schwieriges Problem: Nach Ausschluß aller möglichen anderen, wenn auch sehr viel selteneren Ursachen einer Hyperkalzämie muß die Ursache der Persistenz in einem inadäquaten operativen Vorgehen gesehen werden. Von 414 zwischen 1986 und 1994 an der Chirurgischen Abteilung der Universität Düsseldorf operierten Patienten handelte es sich bei 32 Patienten um einen Reeingriff wegen persistierender Hyperkalzämie. 24 der 32 Patienten waren auswärts voroperiert werden. Intraoperativ fand sich bei 27 Patienten (84%) als Ursache der Hyperkalzämie ein solitäres Adenom, bei 2 Patienten ein Doppeladenom und bei 2 Patienten eine primäre Hyperplasie. Bei einem Patienten blieb die Reexploration erfolglos. 17 Nebenschilddrüsen lagen in ektopen Positionen. 11 Patienten werden wegen einer rezidivierenden Hyperkalzämie operiert. Ursache des Rezidivs war in 2 Fällen ein Doppeladenom und in 8 Fällen (73%) eine Hyperplasie; bei einem Patienten konnte beim Rezidiveingriff keine vergrößerte Nebenschilddrüse gefunden werden. Trotz einer nur zu 32 % korrekten präoperativen Lokalisationsdiagnostik und einem hohen operations-technischen Anspruch lag die Erfolgsrate beim Reeingriff bei 95%.

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Authors and Affiliations

  1. Klinik für Allgemein- und Unfallchirurgie, Düsseldorf, Germany

    C. Dotzenrath, P. E. Goretzki &  H. D. Röher

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  1. C. Dotzenrath
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  2. P. E. Goretzki
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  3. H. D. Röher
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Dotzenrath, C., Goretzki, P.E. & Röher, H.D. Operative strategie bei persistenz und rezidiv in der chirurgie des primären hyperparathyreoidismus. Langenbecks Arch Chir 379, 218–223 (1994). https://doi.org/10.1007/BF00186361

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