Mózes Géza, Curlee Kathleen J, Rowland Charles M, van Heerden Jon A, Thompson Geoffrey B, Grant Clive S, Farley David R
Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
J Am Coll Surg. 2002 Feb;194(2):126-30. doi: 10.1016/s1072-7515(01)01139-5.
Despite extensive preoperative imaging and intraoperative "gadgetry" to facilitate localization of abnormal parathyroid glands, the onus of identification and resection remains with the surgeon in the operating room. We pondered the relative usefulness of routine laboratory studies to the surgeon as predictive guides to the intraoperative findings in patients with primary hyperparathyroidism (HPT).
Pre- and postoperative laboratory data were analyzed in 166 consecutive patients (1998 to 1999) undergoing successful cervical exploration for sporadic primary HPT and were correlated with the pathologic findings. Patients with secondary HPT, multiple endocrine neoplasia, familial HPT, and parathyroid carcinoma were not included in this study.
One hundred eighteen women and 48 men (mean age = 63 years) with parathyroid adenoma (n = 155) and sporadic hyperplasia (n = 11) were evaluated. Mean parathormone (PTH) levels varied little with the pathology: adenoma = 9.6 pmol/L and hyperplasia = 10.2 pmol/L (p > 0.05). In patients with parathyroid adenoma, analysis of preoperative measures showed a positive correlation (r = 0.48, p < 0.0001) with PTH and gland weight. The correlation appeared to be the strongest in the tails of the distribution; in 22 of 23 (96%) cases with PTH levels lower than 6 pmol/L, the offending lesion or lesions were less than 400 mg; in all six cases with PTH levels higher than 18.0 pmol/L, the abnormal gland or glands weighed more than 800 mg. PTH levels between 6 and 18 pmol/L revealed mean adenoma weight of 757 mg (median = 420 mg; range = 50 to 5,500 mg).
Extreme values of PTH in patients with single-gland parathyroid disease alert the surgeon to the likelihood of small or large parathyroid adenomas. Laboratory studies do not differentiate adenoma from hyperplasia, nor do they pinpoint the size of abnormal glands with moderate-range PTH values.
尽管术前进行了广泛的影像学检查，并在术中使用了各种“小工具”以促进异常甲状旁腺的定位，但识别和切除甲状旁腺的责任仍落在手术室中的外科医生身上。我们思考了常规实验室检查对外科医生预测原发性甲状旁腺功能亢进症（HPT）患者术中发现的相对有用性。
分析了1998年至1999年连续166例因散发性原发性HPT成功接受颈部探查的患者的术前和术后实验室数据，并将其与病理结果相关联。继发性HPT、多发性内分泌腺瘤、家族性HPT和甲状旁腺癌患者未纳入本研究。
评估了118名女性和48名男性（平均年龄 = 63岁），其中甲状旁腺腺瘤患者155例，散发性增生患者11例。甲状旁腺激素（PTH）平均水平随病理变化不大：腺瘤患者为9.6 pmol/L，增生患者为10.2 pmol/L（p > 0.05）。在甲状旁腺腺瘤患者中，术前测量分析显示PTH与腺体重量呈正相关（r = 0.48，p < 0.0001）。这种相关性在分布的尾部似乎最强；在23例PTH水平低于6 pmol/L的病例中，有22例（96%）的致病病变小于400 mg；在所有6例PTH水平高于18.0 pmol/L的病例中，异常腺体重量超过800 mg。PTH水平在6至18 pmol/L之间时，腺瘤平均重量为757 mg（中位数 = 420 mg；范围 = 50至5500 mg）。
单发性甲状旁腺疾病患者的PTH极值提醒外科医生注意小或大甲状旁腺腺瘤的可能性。实验室检查无法区分腺瘤和增生，也无法精确确定PTH值处于中等范围时异常腺体的大小。
