- 期刊
Video-Assisted Thoracoscopic Surgery for Mediastinal Parathyroid Adenoma-A Case Report and Literature Review
胸腔鏡手術治療縱膈腔副甲狀腺瘤：一病例報告及文獻回顧
摘要
原發性副甲狀腺機能亢進是造成高血鈣血症最常見的原因，約有25%原發性副甲狀腺機能亢進是由縱膈空副甲狀腺瘤引致。在這些異位性縱膈腔副甲狀腺瘤的病例當中，約有l－2％需要採開胸手術切除，然而開胸手術伴隨有相當比例的合併症(19-29%)。隨著內視鏡手術的發達，各種不同的內視鏡技術已經陸續應用在縱膈腔副甲狀腺腫瘤的切除上，包括胸腔鏡，縱膈腔鏡及劍凸下腹腔鏡手術。胸腔鏡手術因為發展較早及視野良好而最多人採用，胸腔鏡手術除了可以有效避免開胸手術所帶來的大傷口及合併症外，截至目前為止文獻上記載的28例胸腔鏡手術切除縱膈腔副甲狀腺腫瘤案例，均能順利完成手術。 我們報告一個七十八歲的男性病例，在4年來他因為反覆尿路結石接受了震波碎石術並有慢性腎衰竭症狀。經門診驗血發現有高血鈣血症及副甲狀腺機能亢進（副甲狀腺素濃度261pg/ml；正常值＝10-50pg/ml）。頸部超音波無異常發現，鉈99m掃描於縱膈腔發現有異常顯影並且在電腦斷層攝影發現有前縱膈腔腫瘤，患者接受了胸腔鏡手術切除縱膈腔副甲狀腺腫瘤，術後復原良好且血鈣及副甲狀腺素濃度均恢復正常，截至目前為止並無腫瘤再復發的情形發生。
並列摘要
Primary hyperparathyroidism is the most common cause of hypercalcemia, and 25% of primary hyperparathyroidism is caused by ectopic mediastinal parathyroid glands [1]. In approximately 1-2% of the cases, the ectopic gland is in the mediastinum in a location that requires a thoracic approach [2]. A large hyperfunctioning parathyroid adenoma in the deep mediastinum is relatively rare, and may be safely resected using video-assisted thoracoscopic surgery to avoid an open surgical procedure. Only 28 patients who underwent video-assisted thoracoscopic surgical (VATS) resection of mediastinal parathyroid tumors have been reported in the world literature to date [1,3-5]. We herein describe our experience with the successful removal of a large anterior mediastinal parathyroid adenoma by video-assisted thoracoscopic surgery in a patient presenting with repeated ureteral stones. To our knowledge, this is the first reported case of thoracoscopic surgery for a mediastinal parathyroid adenoma in Taiwan [13-15].
延伸閱讀
- Wu, Y. K., Tsai, S. C., Chen, C. C., & Huang, M. H. (2002). 核醫引導在副甲狀腺微創切除術上的應用：病例報告及文獻回顧. 秀傳醫學雜誌, 3(4), 147-150. https://www.airitilibrary.com/Article/Detail?DocID=15610497-200210-3-4-147-150-a
- Zih-Sian Yang、Wen-Hung Wang（2022）。射頻消融術在副甲狀腺瘤上的應用─病例報告和文獻回顧。台灣耳鼻喉頭頸外科雜誌，57(4)，309-315。https://doi.org/10.6286/jtohns.202212_57(4).309
- Hsu, N. Y., Chang, C. L., Sun, S. S., Shih, C. S., & Chen, P. R. (2003). 視訊輔助胸腔鏡手術切除異位縱膈腔副甲狀腺腺瘤. Mid-Taiwan Journal of Medicine, 8(Commemorative), 332-335. https://doi.org/10.6558/MTJM.2003.8(C).12
- Ko, H. J., & Hsu, W. H. (2002). 縱膈腔副甲狀腺囊腫：病例報告及文獻回顧. 胸腔醫學, 17(2), 178-181. https://www.airitilibrary.com/Article/Detail?DocID=10239855-200206-17-2-178-181-a
- Chang, H., Chen, J. C., Nieh, H., & Lee, S. C. (2003). 縱膈腔副甲狀腺腺瘤病例報告及文獻回顧. 胸腔醫學, 18(4), 338-343. https://www.airitilibrary.com/Article/Detail?DocID=10239855-200308-18-4-338-343-a