[Surgical treatment for patients with primary hyperparathyroidism]

To evaluate the feasibility and efficacy of surgical treatment for patients with primary hyperparathyroidism (pHPT).

The studies were analyzed for 55 patients with pHPT who underwent parathyroidectomy in our hospital from 1985 to 2002.

Eight patients were asymptomatic. The skeletal manifestations were found in 24 cases, urinary stones in 10 cases, and both skeletal manifestations and urinary stones in 13 cases. Pathological bone fractures occurred in 16 cases. Hypercalcemia was discovered in all patients with the average value of (3.1 +/- 0.4) mmol/L, ranging from 2.7 to 3.9 mmol/L and. Fifty patients showed elevated parathyroid hormone (PTH) with the average value of (489.2 +/- 69.2) pg/ml, ranging from 102 to 2,000 pg/ml. Preoperatively all patients underwent sonography, CT and/or scintigraphy. The overall preoperative image-directed localization rate was 90.9%. Follow-up was done from 6 months to 2 years after surgery. The symptoms and signs of all patients relieved postoperatively with the improving of osteoporosis and healing of bone fracture. Of all cases, 39 presented with temporary hypocalcemia, 37 showed circumoral paresthesia in whom 10 showed tetany, 15 showed eucalcemia and one had mild hypercalcemia after operation. The serum calcium was normal in all cases with hypocalcemia by Rocaltrol and calcium supplementation for 1 - 3 weeks. PTH level decreased to normal fro 2 weeks to 2 months in 47 cases and was still mildly higher than normal in 3 cases.

Parathyroidectomy is an effective approach to patients with pHPT. With preoperative image-directed localization techniques, minimally invasive parathyroidectomy is a valid surgical strategy.