Microwave Ablation Treatment of Primary Hyperparathyroidism: Experience Sharing and Literature Review

摘要

Primary hyperparathyroidism (PHPT) is due to abnormal secretion of parathyroid hormone (PTH) from parathyroid tissue. It acts on the bones, kidneys, and small intestine, causing systemic diseases such as calcium, phosphorus, and bone metabolic disorders. Surgery is the only effective treatment for PHPT. Some patients with PHPT cannot undergo surgical treatment due to surgical contraindications or failure to tolerate surgery. With the development of minimally invasive techniques, ethanol injection and thermal ablation treatment method have been reported, and have a good prognosis. Our hospital successfully applied microwave ablation technology to treat a patient with primary hyperparathyroidism. Parathyroid tumors have a soft texture, mostly oblate, round cake-like, usually located on the dorsal side of the thyroid, adjacent to the nerve vessels, lacking a solid support around them. During the microwave ablation, glands are prone to retreat, at this time, we should pay attention to the operating range. In conjunction with liquid barriers, repeatedly piercing. When the ultrasound probe shows that the ablation needle has been punctured into the tumor, it is recommended that the operator press the ablation needle posteriorly to press the front end of the needle to try to keep it away from the recurrent laryngeal nerve. At the same time, due to the brittle and fragile texture of parathyroid tissue, in order to achieve a thorough effect of ablation, it is necessary to expand the scope of ablation as much as possible. Therefore, the range of ablation is suggested to include adjacent thyroid and fibrous connective tissue. The liquid barrier method allows the gland to be isolated from the major blood vessels and vital nerves of the neck, and at the same time absorbs heat from ablation, avoids heat injury to the recurrent laryngeal nerve, and reduces the risk of surgery and neck discomfort. The successful treatment of this patient showed that microwave ablation of PHPT is a safe and effective method. The technique is minimally invasive and does not require general anesthesia. It has lower requirements for patients' cardiopulmonary function and is especially suitable for elderly patients and patients with multiple organ diseases. At present, there are few reports on microwave ablation technology for the treatment of PHPT in China. There is no relevant report on the operation experience sharing in surgery. This article summarizes one case of microwave ablation technology for the successful treatment of PHPT for your reference.