Primer hiperparatiroidizmde cerrahi tedavi ve sonuçları

SuleymanDemirel Universitesi TIP FAKULTESI DERGISI: 2001 Aralik; 8(4) Primer hiperparatiroidizmde cerrahi tedavi ve sonuclan Ahmet Kocakusak, Orcun Oral Şenturk, Haldun Sunar, Soykan Arikan, Muzaffer Akinci Ozet Bu calismada primer hiperparatiroidizm nedeni ile 1996-2002 yillari arasinda cerrahi servisimizde ameliyat edilen 11 hastanin tedavi sonuclarini literatur esliginde degerlendirdik. Olgularin tamami kadin olup, ortala­ma yas 52.7(40-73 yas arasi degisen sekilde)'idi. Ortalama takip suresi 9.2 aydir (3-16 ay arasi degisen sekilde). Semptomlarin ortaya cikisi ile tara arasinda gecen sure ortalama 22.4 aydir(4-48 ay arasi degisen sekilde). Tum hastalarda osteodistrofik degisiklikler mevcuttu.Asemptomatik hastamiz yoktu. Ameliyat oncesi lokalizasyon calismalari arasinda ultrasonografi(USG), manyetik rezonans goruntuleme (MRI) ve Tc-sesta MIBI 99m sintigrafisine (Sg) yer verildi.Onbir hastamizin dokuzuna bir cerrahi girisim yeterli olurken,bir hastamizda ameliyat sonrasi patolojinin lenf nodulu ile uyumlu gelmesi diger bir hastamiz­da ise piyesin normal ektopik tiroid dokusu oldugu seklinde rapor edilmesi uzerine bu iki hastaya mukerrer cerrahi girisim uygulanmasi gerekmistir. Sonuc olarak ulkemizde primer hiperparatiroidizm henuz yeterince dikkat cekmeyen bir hastalik olup hastalarin tarasi nadiren asemptomatik evrede konabilmektedir. Buna karsin bati kaynakli literaturlerde opere edilen hastalarin buyuk cogunlugu asemptomatiktir. Asemptomatik hastalarda olusabilecek komplikasyonlarla bas edebilmek guc oldugu icin bu tur hastalara dahi cerrahi oner­ilmelidir. Hastalar ameliyat sonrasi kendilerini daha iyi hissetmekle birlikte /semptomlarindan tamamen arin­malari nadirdir. Tum bunlara ragmen hiperparatiroidizmde cerrahi vazgecilmez tedavi modalitesidir. Anahtar Kelimeler: Primer hiperparatiroidizm,goruntuleme yontemleri,semptomlar. Abstract Abstract Surgical treatment and results of pnmary hyperparathyroidism in this study we aimed to evaluate the results of surgical treatment of 11 patients who were treated for pri-mary hyperparathyroidism and followed up in the outpatient clinic of our hospital between 1996-2002. Ali the patients were women with a mean age of 52.7(between 40-73 years).The mean follow-up time was 9.2 months(between 3-16 months).The mean period of time since onset of symptoms tul diagnosis was 22.4 months(between 4-48 months). Ali the patients had osteodystrophic changes.There were not any asympto-matic patient in our study group. Preoperative localisation studies included ultrasonography(USG) ,magnetic resonance imaging (MRI) and Tc -sesta MIBI 99m scintigraphy (Sg). One staged initial operation was enough in 9 patients,whereas a second operation was needed in 2 patients. in conclusion, primary hyperparathy­roidism is stili an underestimated disease in Turkey and patients are rarely asymptomatic due to delayed diagnosis. According to the western literature however, most of the patients are reported to be asymptomatic. Patients do feel better but they are rarely free of symptoms after surgery. Surgery should be offered even to the asymptomatic patients, because the treatment of possible future complications might be extremely dif-ficult. Although these outcomes, surgery stili remains as the only treatment modality for primary hyper­parathyroidism. Key Words: Primary hyperparathyroidism,imaging studies,symptoms.