Chirurgie des Hyperparathyreoidismus

Zusammenfassung

Der größte Anteil der Nebenschilddrüsenchirurgie entfällt auf den primären Hyperparathyreoidismus, für den ursächlich das solitäre Nebenschilddrüsenadenom überwiegt. Die gesicherte Diagnose des primären Hyperparathyreoidismus indiziert prinzipiell die einzig kurative Therapie, die Operation. Für eine erfolgreiche Operation und v. a. für ein fokussiertes Vorgehen ist die präoperative Lokalisation sehr hilfreich, aber eine negative oder inkonklusive Lokalisation stellt keine Kontraindikation zur Operation dar. In der modernen Hyperparathyreoidismuschirurgie kommen technische Hilfsmittel wie Lupenbrille, intraoperative PTH-Bestimmung und intraoperatives Neuromonitoring zum Einsatz. Hyperparathyreoidsmusformen, die mit einer Mehrdrüsenerkrankung einhergehen, erfordern eine bilaterale Exploration und eine abgewogene, individuell angepasste Entscheidung zum Ausmaß der erforderlichen Nebenschilddrüsenresektion. Insbesondere Wiederholungseingriffe bei Persistenz oder Rezidiv eines Hyperparathyreoidismus sollten nur in Zentren mit ausgewiesener endokrin-chirurgischer Expertise und moderner technischer Ausstattung durchgeführt werden.

Abstract

The majority of parathyroid surgeries are performed for primary hyperparathyroidism, where a solitary parathyroid adenoma is causative. In confirmed primary hyperparathyroidism, surgery as the only curative therapy is principally indicated. Modern preoperative parathyroid adenoma imaging techniques favorably aid surgery, especially in focused parathyroidectomy. However, if imaging remains negative or inconclusive this does not preclude surgery. In modern hyperparathyroidsm surgery, technical adjuncts like magnification loops, intraoperative PTH-assay, and intraoperative neuromonitoring are applied. In hyperparathyroidism that is caused by multiglandular disease, bilateral exploration becomes necessary, and individually tailored extent of parathyroidectomy is evaluated with respect to the patients` demands. Especially in persistent or recurrent hyperparathyroidism surgery, designated endocrine-surgical expertise and modern technical equipment are mandatory.

Schlüsselwörter

Hyperparathyreoidismus - Lokalisationsdiagnostik - fokussierte Parathyreoidektomie - intraoperative PTH-Bestimmung - bilaterale Exploration

Keywords

hyperparathyroidism - localization imaging - focused parathyroidectomy - intraoperative PTH-assay - bilateral exploration

Publication History

Article published online:
21 September 2020

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