乙醇消融
还曾尝试过甲状旁腺原位乙醇消融治疗,但结果不一。[85]Harman CR, Grant CS, Hay ID, et al. Indications, technique, and efficacy of alcohol injection of enlarged parathyroid glands in patients with primary hyperparathyroidism. Surgery. 1998 Dec;124(6):1011-9.http://www.ncbi.nlm.nih.gov/pubmed/9854577?tool=bestpractice.com[86]Singh Ospina N, Thompson GB, Lee RA, et al. Safety and efficacy of percutaneous parathyroid ethanol ablation in patients with recurrent primary hyperparathyroidism and multiple endocrine neoplasia type 1. J Clin Endocrinol Metab. 2015 Jan;100(1):E87-90.http://www.ncbi.nlm.nih.gov/pubmed/25337928?tool=bestpractice.com[87]Alherabi AZ, Marglani OA, Alfiky MG, et al. Percutaneous ultrasound-guided alcohol ablation of solitary parathyroid adenoma in a patient with primary hyperparathyroidism. Am J Otolaryngol. 2015 Sep-Oct;36(5):701-3.http://www.ncbi.nlm.nih.gov/pubmed/26026702?tool=bestpractice.com 在该疗法中,在超声引导下乙醇经皮注入到腺瘤中。并未观察到血钙可长期维持正常。有喉返神经损伤的报道。
机器人手术
需要进行随机对照临床试验来评估机器人辅助甲状旁腺切除术的结局。[88]Arora A, Cunningham A, Chawdhary G, et al. Clinical applications of Telerobotic ENT-Head and Neck surgery. Int J Surg. 2011;9(4):277-84.http://www.ncbi.nlm.nih.gov/pubmed/21276879?tool=bestpractice.com[89]Bearelly S, Prendes BL, Wang SJ, et al. Transoral robotic-assisted surgical excision of a retropharyngeal parathyroid adenoma: A case report. Head Neck. 2015 Nov;37(11):E150-2.http://www.ncbi.nlm.nih.gov/pubmed/25809987?tool=bestpractice.com
超声引导下高强度聚焦超声
一项小型研究显示大部分患者的血清钙下降,但并不能根治原发性甲状旁腺功能亢进。副作用值得关注,其中有 23% 的患者出现一过性声带损伤。[90]Kovatcheva R, Vlahov J, Stoinov J, et al. US-guided high-intensity focused ultrasound as a promising non-invasive method for treatment of primary hyperparathyroidism. Eur Radiol. 2014 Sep;24(9):2052-8.http://www.ncbi.nlm.nih.gov/pubmed/24895038?tool=bestpractice.com
机器学习以发现多腺体病
机器学习是一个不断发展的领域,有许多不同的应用。机器学习涉及应用一系列的方法,让计算机能够从已知/现有数据集中学习规则以进行预测。一些研究人员正在探索其在术前鉴别多腺体病和单个腺瘤中的用途,从而优化手术计划。[91]Imbus JR, Randle RW, Pitt SC, et al. Machine learning to identify multigland disease in primary hyperparathyroidism. J Surg Res. 2017 Nov;219:173-9.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5661967/http://www.ncbi.nlm.nih.gov/pubmed/29078878?tool=bestpractice.com