Vergès B, Cercueil J P, Jacob D, Vaillant G, Brun J M
Service d'endocrinologie, diabétologie et maladies métaboliques, hôpital du Bocage, centre hospitalier universitaire de Dijon, France.
Ann Chir. 2000 Jun;125(5):457-60; discussion 460-1. doi: 10.1016/s0003-3944(00)00221-2.
The objective of this retrospective study was to report the results of ethanol injection in parathyroid adenomas.
Since 1988, 31 patients with inoperable primary hyperthyroidism have been treated by ultrasound-guided percutaneous ethanol injection into the adenoma. The main surgical contraindications were heart failure (n = 12) and age over 85 years (n = 11). Plasma calcium and PTH were measured 48 hours after ethanol injection and during subsequent follow-up.
Patients had one to three ethanol injections. With a mean 5-year follow-up, total success with normal plasma calcium and PTH levels was achieved in 20 patients (64.5%), 4 of whom underwent another ethanol injection after 1 to 3 years. Partial success with correction of plasma calcium only was achieved in 9 patients (29%) resulting in an obvious clinical benefit. Failure was observed in 2 patients (6.5%) with nodular goiter, probably due to incorrect localization of the adenoma. Treatment was always well tolerated and no major side effect was observed.
Ultrasound-guided percutaneous ethanol injection of parathyroid adenoma is effective in most cases of hyperparathyroidism and very useful in patients with a high surgical risk. The need for precise ultrasound localization of the adenoma is the main limitation of this treatment.
本回顾性研究的目的是报告乙醇注射治疗甲状旁腺腺瘤的结果。
自1988年以来，31例无法手术的原发性甲状旁腺功能亢进患者接受了超声引导下经皮乙醇注射腺瘤治疗。主要手术禁忌证为心力衰竭（12例）和年龄超过85岁（11例）。在乙醇注射后48小时及随后的随访期间测量血浆钙和甲状旁腺激素（PTH）。
患者接受了1至3次乙醇注射。平均随访5年，20例患者（64.5%）血浆钙和PTH水平恢复正常，治疗成功，其中4例在1至3年后接受了再次乙醇注射。9例患者（29%）仅血浆钙得到纠正，部分成功，临床症状明显改善。2例结节性甲状腺肿患者治疗失败（6.5%），可能是由于腺瘤定位错误。治疗耐受性良好，未观察到严重副作用。
超声引导下经皮乙醇注射甲状旁腺腺瘤对大多数甲状旁腺功能亢进病例有效，对手术风险高的患者非常有用。腺瘤需要精确的超声定位是该治疗的主要局限。
