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Một quét technetium-99m-sestamibi Được thể hiện được đánh dấu-hấp thu vào ngực người phụ nữ này 78 tuổi, với cường cận giáp đầu ngực là (a), ngang (b) và dọc (c) xem. Một CT scan (d) một nhân tiếp giáp với vòng cung động mạch chủ WS cần chú ý. Một u tuyến cận giáp cắt bỏ WS (e) | 274 Roses Figure 2 A technetium-99m-sestamibi scan demonstrated marked uptake in the chest in this 78-year-old woman with hyperparathyroidism on early chest a transverse b and sagittal c views. On CT scan d a nodule was noted adjacent to the aortic arch. A parathyroid adenoma was excised e through a limited anterior parasternal incision Chamberlain approach . Copyright Marcel Dekker Inc. All rights reserved. Reoperation For Primary Hyperparathyroidism 275 Table 2 Results of Reoperations for Persistent or Recurrent Hyperparathyroidism Author s Ref. Year No. of patients Cured Wang 12 1977 112 91 Brennan and Norton 29 1985 175 90 Grant et al. 10 1986 157 89 Levin 43 1989 81 91 Cheung et al. 102 1989 83 86 Rothmund et al. 100 1990 70 96 Carty and Norton 13 1991 206 95 Jarhult et al. 64 1993 93 82 Rodriguez et al. 14 1994 152 93 Shen et al. 15 1996 102 95 Jaskowiak et al 16 1996 222 97 Mariette et al. 65 1998 38 92 Thompson et al. 17 1999 124 88 parasternal approach. More recently video-assisted thoracoscopy has successfully allowed excision of mediastinal parathyroid adenomas that were precisely localized preoperatively 96 97 . Special considerations apply to the patient treated for parathyroid cancer or likely to have parathyroma-tosis. Patients who had previous treatment for parathyroid carcinoma may develop recurrent disease in the neck. Localizing studies in patients with recurrent parathyroid carcinoma may be helpful but do not detect all foci of disease 27 . In patients with familial histories of hyperparathyroidism as well as with MEN syndromes prior procedures may lead to the implantation of hyperplastic parathyroid tissue in the surgical field. Meticulous assessment of the prior surgery a more extensive use of localizing procedures and more complete and thorough explorations may be required to ablate hyperplastic parathyroid tissue in this situation and once again the intraoperative QPTH may have particular efficacy. 10 SUCCESS AND MORBIDITY Results of large .
