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Abstract
Primary hyperparathyroidism (PHPT) is the third most common endocrine disease after diabetes mellitus and thyroid disease. Surgical intervention is the method for treatment of primary hyperparathyroidism. Currently, two approaches are used when performing parathyroidectomy (PTE): operation with bilateral revision of the parathyroid glands (PTG), performed through the Kocher approach, and focused unilateral PTE using minimally invasive technologies and intraoperative monitoring of parathyroid hormone (IM PTG). Adherents of bilateral revision justify a wider examination of the PTGs by the frequency of uninformative conclusions of topical diagnostic methods (up to 40%), as well as the incidence of development of multiglandular disease (MGD) of the PTG (up to 33%). Followers of focused minimally invasive PTE are guided by evidence from studies showing no statistically significant difference in treatment outcomes between the two approaches and improvements in such indicators as the duration of surgery, length of hospital stay, cost of surgery, and unconditional cosmetic effect. The aim is to compare the results of treatment of patients with PHPT when using IM PTH (mainly with minimally invasive surgical interventions) or when determining the PTH level one day after the completion of the operation (mainly by the classical method with revision of all PTGs). Material and methods. To evaluate the effectiveness of the IM PTH method, 2 groups of patients were formed: the first (18 patients), in which PTH was determined intraoperatively 10-15 minutes after the removal of the PTG formation/formations, and the second (17 patients), in which PTH was determined the next day in planned order. Results. When comparing two groups of patients, we did not reveal a statistically significant difference between the results of treatment achieved using a minimally invasive approach and IM PTH and when performing PTE according to the classical technique with a visual assessment of all PTGs. Conclusions. IM PTH in terms of diagnostic effectiveness is not inferior to the assessment of the PTH level after surgery. The use of IM PTH allows performing PTE without the obligatory visual assessment of all PTGs. The performance of MI PTE with MI PTH demonstrates obvious advantages over classical
approaches in the treatment of PHPT.
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Чернишов СВ, винахідник; Чернишов СВ, правовласник. Спосіб мінімально інвазивного доступу до щитоподібної залози. Патент України № 52522. Листопад 10, 2010 (Chernyshov SV, inventors; Chernyshov SV, assignee. Method of minimally invasive access to the thyroid gland. Patent of Ukraine 52522. Nov 10, 2010). Ukrainian.