Abstract
Reoperation for persistent or recurrent hyperparathyroidism is more hazardous than is primary cervical exploration and is also much less likely to result in cure of the disease. Only 21 of 34 reoperations (62%) were successful during the period 1970 through 1972 at the Mayo Clinic, compared with success in 312 of 327 primary operations (95%). In 9 patients who had their initial exploration at this institution, the most common cause of failure at the first operation was inadequate treatment of multiglandular disease; in 25 patients who were first operated on elsewhere, missed adenomas were far more common.
Parathyroid arteriography and selective venous sampling with parathyroid hormone assays should improve the results of reoperation by providing preoperative localization of hyperfunctioning parathyroid glands in difficult cases. These procedures, however, are expensive and technically difficult, and they are not always successful. They are also associated with a definite morbidity, which must be weighed against any anticipated benefits. The systematic evaluation and treatment of patients facing reoperation for hyperparathyroidism should be undertaken in special centers accustomed to dealing with these difficult problems.
Résumé
Lorsqu'il faut réopérer un malade pour hyperparathyroïdie persistante ou récidivante, le risque est plus élevé qu'à la première exploration et les chances de succès sont moindres. Sur 34 réinterventions faites à la Mayo Clinic entre 1970 et 1972, nous avons 21 succès (62%), pour 312/327 premières opérations (95%). Chez 9 malades dont l'exploration initiale avait été faite dans notre hôpital, la cause la plus fréquente d'échec de l'opération princeps était un traitement inadéquat d'une maladie multiglandulaire; pour 25 malades opérés ailleurs la première fois, l'erreur la plus fréquente avait été la non découverte d'un adénome parathyroïdien.
L'artériographie des parathyroïdes et le cathétérisme sélectif des troncs veineux de la base du cou avec dosage de la parathormone devraient améliorer les résultats des réinterventions, par une meilleure localisation pré-opératoire des glandes hyperfonctionnelles dans les cas difficiles. Mais ces examens sont coûteux, sont techniquement difficiles et peuvent échouer. De plus, ils ne sont pas sans danger et il faut bien peser le risque et le bénéfice que l'on peut en attendre. La mise au point et le traitement des malades qui doivent être réopérés pour hyperparathyroïdie doit se faire dans des centres spécialisés ayant l'habitude de traiter ces problèmes difficiles.
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Edis, A.J., Beahrs, O.H. & Sheedy, P.F. Reoperation for hyperparathyroidism. World J. Surg. 1, 731–736 (1977). https://doi.org/10.1007/BF01555926
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DOI: https://doi.org/10.1007/BF01555926