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Objective To explore the feasibility and clinical outcome of lateral cervical incision via sternocleidomastoid intermuscular approach(SMIA)in the treatment of primary hyperparathyroidism.Methods The clinical data of 64 patients with primary hyperparathyroidism who underwent unilateral parathyroid surgery in the First Affiliated Hospital,School of Medicine of Zhejiang University from January 2019 to June 2022 were retrospectively analyzed.They were divided into lateral cervical incision via sternocleidomastoid intermuscular approach group(SMIA group)and linea alba cervicalis approach group(LACA group)based on the surgical incision and access route.The differences in clinical features,surgery-related outcomes and postoperative functions of the anterior cervical region were compared between the two groups.The EQ-5D-5L scale was used to assess the subjective feeling of postoperative neck discomfort,while the Hollander Wound Assessment Scale was used to assess the clinical outcome of incision healing.Results There were no statistical differences between the two groups of patients in terms of age,gender,intraoperative bleeding,parathyroid hormone or blood calcium levels before and after surgery(P＞0.05).The duration of surgery was significantly shorter in the SMIA group than in the LACA group[(39.77±5.69)min vs.(54.41±4.66)min].There was a statistical difference between the two groups in functional protection of the anterior cervical region at 1 month and 12 months after surgery(1 month,84.67±3.74 vs.79.47±5.38,P＜0.001;12 months,93.80±2.52 vs.89.94±2.39,P＜0.001),and the SMIA group was better than the LACA group.The Hollander Incision Assessment Scale scores of the SMIA group were better than those of the LACA group at 6 months and 12 months after surgery,and the difference was statistically significant(6 months,1.93±0.58 vs.2.41±0.66,P=0.003;12 months,1.03±0.67 vs.1.74±0.62,P＜0.001).Conclusion Parathyroidectomy via sternocleidomastoid intermuscular approach through lateral cervical incision is a simple,safe and effective surgical procedure,which makes it easier to search for parathyroid lesions and shortens the surgical time compared with the traditional incision,and has obvious advantages in the protection of anterior cervical region function.
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Objective:To investigate the feasibility and advantages of unilateral primary hyperparathyroidism (PHPT) treated by transthyretal interosseous muscle approach surgery.Methods:Clinical data of 7 patients with unilateral PHPT treated by interstitial sternocleidomastoid muscle approach from Jan. 2021 to Feb. 2022 in the thyroid surgery of China-Japan Union Hospital of Jilin University were retrospectively analyzed, including preoperative blood calcium concentration, operation time, incision length, intraoperative parathyroid hormone (PTH) , blood calcium concentration and PTH value in the first month after surgery, abnormal sensation of the skin in the anterior cervical area, etc. The feasibility and advantages of interstitial sternocleidomastoid muscle approach surgery for unilateral PHPT were analyzed.Results:All 7 patients with unilateral PHPT were operated successfully. The PTH was 17.2-63.3 pg/ml on recheck 1 month after surgery, which were all within the normal range. The time from skin opening to resection of the diseased parathyroid gland was 20-35 min, and the length of the surgical incision was 3-4 cm. all patients were given intravenous and oral calcium therapy after surgery, and the blood calcium and PTH levels were within the normal range at 3-12 months of follow-up; the incision recovered well, and there was no significant sensory and functional abnormalities in the anterior neck area.Conclusion:The treatment of unilateral PHPT through the sternocleidomastoid interosseous approach can ensure the safety and efficacy of the operation while better protecting the sensory and motor functions of the anterior cervical region and improving the aesthetics of the surgical incision.
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Objective:To evaluate the clinical efficacy of endoscope assisted supraclavicular thyroidectomy and lymph node dissection through the sternocleidomastoid muscular approach (ELDS) .Methods:Clinical data of 40 patients undergoing ELDS and 40 patients who had open surgery (open group) by same team admitted to Ningbo Medical Center Lihuili Hospital from Jan. 2021 to Jan. 2022 were retrospectively analyzed. The intraoperative and postoperative outcomes and follow-up were observed situation. The intraoperative situation, the number of lymph nodes dissected, postoperative outcomes and scar healing satisfaction were observed. SPSS 20.0 software was employed to carry out statistical analysis, the measurement date were compared with t-test, and the counting date were analyzed by χ2 test. Results:There was no significant differences in the two groups with respect to the number of lymph nodes dissected (ELDS group: 30.5±9.8, open group: 29.9±9.0) . The surgical injury in ELDS group were significantly smaller than those in open group, and the operation time was significantly higher in open group (ELDS group: 95.2±12.0min, open group: 82.3±13.9min, P<0.05) . In postoperative follow-up, there were significant differences between the two groups in swallowing impairment, anterior cervical pressure and scar satisfaction (ELDS group: 4.45±1.82, open group: 6.03±1.47, P<0.05) , and the lateral approach group was superior to open group, but there were no significant differences in parathyroidism or recurrent laryngeal nerve injury ( P>0.05) . Conclusions:ELDS has the advantages of good cosmetic effect, less postoperative anterior cervical discomfort, less postoperative complications, and good lymph node dissection effect. The operation is safe and feasible, and has obvious advantages over traditional operation.