VIDEO ASISTIRANA TORAKOSKOPSKA RESEKCIJA EKTOPIČNIH MEDIJASTINALNO LOKALIZOVANIH PARATIREOIDNIH ŽLEZDA: ISKUSTVA NAŠEG CENTRA
Sažetak
Uvod/Cilj: Većina ektopično lokalizovanih medijastinalnih paratireoidnih žlezda (EMPTŽ) može se uspešno ukloniti cervikalnim pristupom, uključujući i paratireoidne žlezde (PTŽ) smeštene u gornjem medijastinumu. Međutim 1% – 3% pacijenata sa hiperparatireoidizmom (HPT) zahteva grudno hirurški pristup. Uspeh hirurškog lečenja zavisi od što preciznije preoperativne lokalizacije EMPTŽ-a i izbora odgovarajućeg pristupa. Kod ove grupe pacijenata video asistirana torakoskopska ekscizija (engl. video-assisted thoracoscopic surgery – VATS) EMPTŽ-a se može koristiti kao pouzdana i bezbedna metoda, kako bi se izbegla potreba za otvorenom hirurgijom, kao i zbog drugih prednosti. Prikazujemo prvih 11 pacijenata sa EMPTŽ-om koji su uspešno operisani na Klinici za grudnu i kardiohirurgiju Vojnomedicinske Akademije (VMA). Nema izveštaja o prethodnim VATS resekcijama EMPTŽ-a u Srbiji.
Materijali i metode: Na Klinici za grudnu i kardiohirurgiju Vojnomedicinske akademije, u periodu između marta 2014. i oktobra 2022. godine, video asistiranim torakoskopskim hirurškim pristupom (VATS) je operisano 11 pacijenata sa ektopično lokalizovanim medijastinalnim paratireoidnim žlezdama. Svi pacijenti su imali biohemijski dokazan hiperparatireoidizam (povišene serumske vrednosti kalcijuma i paratireoidnog hormona). Za preoperativno utvrđivanje lokalizacije ektopičnih žlezda, korišćene su: kompjuterizovana tomografija grudnog koša, Tc-99m sestamibi scintigrafija paratireoidnih žlezda i kompjuterizovana tomografija emisijom pojedinačnog fotona (engl. single photon emission computed tomography – SPECT).
Rezultati: Uspešno je izvršena ekscizija svih EMPTŽ-a VATS pristupom. Nije bilo potrebe za otvorenim grudno-hirurškim pristupom (sternotomija ili torakotomija). Prosečna dužina trajanja operacije je iznosila 80 minuta (od 34 do 150 min), a prosečna dužina hospitalizacije je bila 7 dana. Kod jednog bolesnika je došlo do razvoja infekcije operativne rane.
Zaključak: Ektopično lokalizovane medijastinalne paratireoidne žlezde mogu biti bezbedno i uspešno ekscidirane korišćenjem VATS pristupa, čime se izbegava klasično otvaranje grudnog koša. VATS obezbeđuje dobru vizualizaciju tumora, malu traumu tkiva, kratko vreme trajanja operacije, kratko vreme bolničkog lečenja, malu učestalost komplikacija i dobar kozmetički efekat.
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