副甲状腺機能亢進症における外科的治療

Parathyroid Hormone. Surgical treatment for patients with hyperparathyroidism.

　副甲状腺手術は煩雑な手術手技ではないものの，副甲状腺の数や存在位置も個々の症例で違うことから，周囲解剖の熟知と術前からの正確な局在診断が求められる。また，副甲状腺機能亢進症に対する外科的治療は両側検索の時代から一腺摘除の低侵襲手術へ移行してきており，それに伴い術中のラジオガイド法，術中インタクトPTH（iPTH）測定，術中神経モニタリングなどの補助手技も進歩しており，適宜それらを利用した安全・確実な手術が求められている。

　Although parathyroid surgery is not a complicated surgical procedure, enough knowledge of the surgical anatomy and accurate information for localization of involved gland are required from the fact of the variation in the number and the location of the parathyroid gland. Surgical treatment for patients with hyperparathyroidism has been in the transition state from the era of both sides exploration to minimally invasive surgery. In addition, intraoperative radio guide method, intraoperative iPTH measurement, and intraoperative neuromonitoring have been introduced for the safe and reliable operation.