PRİMER HİPERPARATİROİDİ CERRAHİSİ GEÇİREN HASTALARDA PREOPERATİF VE PEROPERATİF PARAMETRELERİN KARŞILAŞTIRILMASI, PREOPERATİF PARAMETRELERİN POSTOPERATİF SEYRİ ÜZERİNE ETKİSİ

Amaç Çalışmamızda, primer hiperparatiroidi (p-HPT) nedeni ile opere edilen hastalarda görüntüleme yöntemlerinin başarısı ve preoperatif bulguların postoperatif sonuçlara etkisi araştırıldı. Gereç ve Yöntem Bu çalışmada Ocak 2008 ile Aralık 2010 tarihleri arasında Yüzüncü Yıl Üniversitesi Tıp Fakültesi Genel Cerrahi kliniği tarafından p-HPT nedeni ile opere edilen 50 ardışık olgunun verileri prospektif olarak incelendi. Çalışma süresi boyunca hastaların demografik verileri, klinik bulguları, ameliyat öncesi ve sonrası laboratuvar sonuçları, ameliyat öncesi dönemde lokalizasyon amacıyla yapılan ultrasonografi (USG), sintigrafi ve bilgisayarlı tomografi (BT) bulguları, ameliyat ve patoloji raporları incelendi ve kaydedildi. Elde edilen veriler istatistiksel olarak analiz edildi. Bulgular Kas iskelet sistemi ağrılarının en sık (%80) hastaneye başvuru nedeni olduğu görüldü. Opere edilen hastalarda ameliyat sonrası serum parathormon (PTH) ve kalsiyum seviyelerinin ameliyat öncesi döneme göre anlamlı oranda düştüğü tespit edildi (p<0.05). İki taraflı boyun diseksiyonu yapılan hastaların oranı %30 idi. Bezlerin histopatolojik incelemesinde hastaların % 88’inde adenom tespit edilirken paratiroid hiperplazisi olarak rapor edilenlerin oranı ise % 12 idi. Ayrıca hastaların % 4’ünde patolojik bezler ektopik yerleşimli (retroözofagial, ön mediasten) iken, % 4 hastada ise çift adenom mevcut idi. USG’nin patolojik bezleri tespit etmedeki sensitivitesi %72 olarak hesaplandı. Bununla birlikte USG’nin ektopik yerleşimli (%4) ve çift adenom (%4) olan lezyonların tamamında doğru lokalizasyon yapamadığı görüldü. Eş zamanlı tiroidektomi yapılan hastalarda, ameliyat sonrası kalsiyum değerleri tiroidektomi yapılmayanlara benzerken 2. gün PTH değeri daha düşük bulunmuştur. Sonuç Ultrasonografi yüksek tanısal değere sahip olmakla birlikte atipik yerleşimli, multipl lezyonlarda yanlış lokalizasyona sebep olabilmektedir. Cerrahi eksplorasyon arttıkça postop hipokalsemi riski artmaktadır.

Anahtar Kelimeler:

Endokrin cerrahi, Paratiroid adenomu, Hiperparatiroidi.

EFFECTS OF PREOPERATIVE FINDINGS ON POSTOPERATIVE RESULTS IN PATIENTS UNDERGOING SURGERY FOR PRIMARY HYPERPARATHYROIDISM

Objective To investigate the success of imaging methods and the effect of preoperative findings on postoperative results in patients who underwent surgery for primary hyperparathyroidism (p-HPT). Material and Method In this study, the data of 50 consecutive patients who underwent p-HPT surgery at the General Surgery Clinic of Yuzuncu Yil University Faculty of Medicine between January 2008 and December 2010 were prospectively analyzed. During the study period, the patients’ demographic data, clinical findings, preoperative and postoperative laboratory results, findings of ultrasonography, scintigraphy, and computed tomography performed for localization in the preoperative period, and surgery and pathology reports were evaluated and recorded. The obtained data were statistically analyzed. Results Musculoskeletal pain was the most common (80%) reason for the patients’ presentation to the hospital. In the operated patients, the serum parathormone and calcium levels significantly decreased compared to the preoperative period (p<0.05). The rate of patients who underwent bilateral neck dissection was 30%. In the histopathological examination of the glands, adenoma lesions were detected in 88% of the patients, and the rate of those with a pathology result of parathyroid hyperplasia was 12%. In addition, 4% of the patients had ectopic pathological glands (retroesophageal, anterior mediastinum), and 4% had double adenomas. The sensitivity of ultrasonography in detecting pathological glands was calculated as 72%. However, ultrasonography did not accurately localize all ectopic (4%) and double adenoma (4%) lesions. The postoperative calcium values were similar between the patients that underwent simultaneous thyroidectomy and those that did not undergo this operation, but the parathormone values measured on the second postoperative day were significantly lower in the former. Conclusion Although ultrasonography has a high diagnostic value, it can cause mislocalization in the presence of multiple lesions with atypical localization. The risk of postoperative hypocalcemia increases as surgical exploration increases.

Keywords:

Endocrine surgery, Parathyroid adenoma, Hyperparathyroidism,

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