Novosti
Khirurgii

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Year 2017 Vol. 25 No 3

GENERAL & SPECIAL SURGERY

V.I. BELOKONEV 1,2, N.E. GALSTYAN 1,2, S.Y. PUSHKIN 1,3, X.V. KOVALEVA1,2, E.V. SELEZNEVA 2

SPECIFIC FEATURES OF SURGICAL TREATMENT OF PATIENTS WITH PRIMARY AND TERTIARY HYPERPARATHYROIDISM

SMEE HPE "Samara State Medical University" 1,
MBE "City Clinical Hospital N1 named after N.I.Pirogov", 2,
SBME "Samara Regional Clinical Hospital named after V.D.Seredavin" 3,
Samara
The Russian Federation

Objectives. To substantiate the indications, volume and operation technique in patients with primary and tertiary hyperparathyroidism in combination with the pathology of the thyroid gland.
Methods. The treatment of patients (n=63) with hyperparathyroidism aged 20-80 years has been analyzed. 23 patients suffered from primary and 40 – tertiary hyperparathyroidism. There were 19 males (31,7%) and 41 females (68,3%). The diagnosis was made on the basis of patients complaints of pain in the bones, muscles, skin itching, the level of total and ionized calcium, inorganic phosphorus and value of parathyrotrophic hormone (PTH > 300 pg/ml). The operations were carried out via a Kocher’s incision on the anterior surface of the neck. In repeated interventions unilateral access according to V.I. Razumovsky was used. Surgeries in patients with primary hyperparathyroidism were aimed to remove the parathyroid adenoma, and with tertiary hyperparathyroidism – to complete removal of the parathyroid glands. Thyroidectomy was performed in combination with the thyroid disease and more rarely its subtotal resection.
Results. Out of 23 patients with primary hyperparathyroidism the removal of adenoma and thyroidectomy was performed in 14 cases, adenoma and subtotal resection of the thyroid gland – in 3. In 18 patients out of 40 with tertiary hyperparathyroidism the removal of hyperplastic parathyroid glands was combined with thyroidectomy, in 7 – with the resection of the thyroid gland. Comparison of ultrasound and CT values with the operational data showed that those methods tentatively indicated the number and locations of parathyroid adenomas. In 23 patients with primary and 37 patients with tertiary hyperparathyroidism the treatment outcomes are good; there were 3 cases of disease recurrence.
Conclusion. Treatment of patients with primary hyperparathyroidism is aimed to remove adenoma and in the case of tertiary hyperparathyroidism – to remove completely the parathyroid glands.

Keywords: primary and tertiary hyperparathyroidism, peculiarities of treatment, volume of operation, Kocher’s incision, recurrence, parathyroid adenoma, thyroidectomy
p. 242-249 of the original issue
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Address for correspondence:
443099, Russian Federation,
Samara, Chapaevskaya str., 89,
Samara State medcal Univesity
Department of surgical diseases N2.
Tel.: +7 846 207-32-83
E-mail: nbelokoneva@yandex.ru
Vladimir I. Belokonev
Information about the authors:
Belokonev V.I. MD, Professor, Honored Physician of the Russian Federation, Head, department of surgical diseases N2, SMEE HPE " Samara State Medical University".
Galastyan N.E. Surgeon, MBE "City Clinical Hospital N1 named after N.I.Pirogov", Senior Laboratory Assistant, department of surgical diseases N2, SMEE HPE "Samara State Medical University".
Pushkin S.Y. Deputy Chief on Surgery, SBME "Samara Regional Clinical Hospital named after V.D.Seredavin", MD, Ass. Professor, department of the surgical diseases N2, SMEE HPE "Samara State Medical University".
Kovaleva Z.V. PhD, Assistant, department of the surgical diseases N2, SMEE HPE "Samara State Medical University".
Starostina A.A. PhD, Surgeon, "City Clinical Hospital N1 named after N.I.Pirogov".
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