Información del artículo
Resumen
La prevalencia y la incidencia del hiperparatiroidismo primario han aumentado más de lo que previamente se había estimado, y su diagnóstico se ha simplificado mucho con el desarrollo del inmunoanálisis para la paratirina. La paratiroidectomía sigue siendo el único tratamiento definitivo de esta enfermedad.
El mayor avance en los últimos años ha sido la mejora de las técnicas de localización con la aparición de la gammagrafía con 99mTc-sestamibi, lo que ha propiciado el desarrollo de una serie de tácticas quirúrgicas que se basan en el acceso limitado a la enfermedad puesta de manifiesto por esta exploración, como la paratiroidectomía mínimamente invasiva, la paratiroidectomía mínimamente invasiva videoasistida y la paratiroidectomía mínimamente invasiva radioguiada; todas con o sin la ayuda de la determinación intraoperatoria de paratirina. La introducción de estos avances en el diagnóstico hace que se cuestione la necesidad de la práctica del acceso clásico con la visualización de las cuatro glándulas paratiroideas.
Los resultados obtenidos por las citadas técnicas son prometedores, pero en la actualidad no se ha demostrado de manera concluyente que sean superiores al acceso clásico, debido a la incompleta o escasa evidencia existente, por lo que es necesaria la realización de estudios diseñados de forma adecuada para su confirmación.
Palabras clave:
Hiperparatiroidismo primario
Tratamiento quirúrgico
Revisión
The incidence and prevalence of primary hyperparathyroidism has increased more than was previously expected and the diagnosis of this disorder has been greatly simplified by the development of the parathyroid hormone (PTH) immunoassay. Parathyroidectomy is still the only definitive treatment.
The greatest advance in the last few years has been improvement in localization techniques with the development of 99mtc—sestamibi scintigraphy, which has favored limited access surgical techniques, such as minimally-invasive parathyroidectomy, video-assisted minimally-invasive parathyroidectomy and radio-guided minimally-invasive parathyroidectomy. all of these techniques can be performed with or without intraoperative pth determination, casting doubt on the need for classical access with visualization of the four parathyroid glands.
The results obtained by these techniques are promising. However, to date there is insufficient evidence to conclusively demonstrate the superiority of these techniques over the classical approach and further, well-designed studies are required.
Key words:
Primary hyperparathyroidism
Surgical treatment
Review
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