Improvement and introduction of innovative methods of surgical treatment of primary hyperparathyroidism

Abstract

Aim. Evaluation of the results of surgical treatment of patients with primary hyperparathyroidism. Material and Methods.Overthe period of2000 to 2019, 180 patients with pancreatic tumors were operated. Among them, there were 30 (16.67%) men and 150 (83.33%) women. The age of patients ranged from 20 to 72 years. All patients were tested for parathyroid hormone, vitamin D3, and ionized blood calcium. Among the instrumental methods, an ultrasound of the thyroid and parathyroidglands was performed prior to surgery and intraoperatively. In case of disturbances of hormonal indices without signs of organic pathology, ultrasound scintigraphy was performed on patients with Tc99 MIBI. Results and Discussion. According to the ultrasound scan results, 95.55% of patients had adenoma of the parathyroidgland, 1.67% - 2 and more adenomas, and 2.78% - hyperplasia of the glands. In 177 patients (98.3%), there was a steady decline in parathyroid hormone and ionized calcium levels within 1to 3 days after surgical intervention and during one-month follow-up (p <0,05). In 4 patients (2,2%) there were surgical complications: in 2 - one-sided persistent larynx paresthesia without disturbance of respiration, and in 2 - one-sided pneumothorax caused by damage to parietal pleura. These complications were successfully eliminated by conservative treatment methods. Subsequently, since 2017, using intravenous anesthesia with artificial ventilation of the lungs helpedto avoid complications such as pneumothorax. Conclusions. The use of intraoperative ultrasound examination allows for a precise location the pathologically altered parathyroid gland with the subsequent application of minimally invasive access. Given the high percentage (95,55%) of single adenomas or hypertrophy of the parathyroid glands and the use of ultrasound on the operating table, examinationt of all parathyroid glands in the GHPT is not considered necessary. The use of ionized calcium screening and modern techniques allowed us to significantly improve the diagnosis of the disease, to shortenthe time of surgery, to reduce the tissue injury and the risk of complications, to have a good cosmetic outcome, to lower the average length of hospitalization to 2-5 days, and to prevent the development of severe complicated forms of the disease.

Keywords

• parathyroid gland adenoma, parathyroidectomy, primary hyperparathyroidism