Jones Julia J, Brunaud Laurent, Dowd Christopher F, Duh Quan-Yang, Morita Eugene, Clark Orlo H
Department of Radiology (Neuroradiology), University of California San Francisco/Mount Zion Medical Center, 1600 Divisadero Street, Room 437, San Francisco, CA 94143-1674, USA.
Surgery. 2002 Dec;132(6):944-50; discussion 950-1. doi: 10.1067/msy.2002.128477.
Preoperative noninvasive localization studies of the neck and mediastinum are beneficial before reoperation. However, the role of selective venous sampling (SVS) for parathyroid hormone (PTH) in reoperative parathyroid surgery has never been clearly defined. The purpose of this study was to evaluate the accuracy of SVS when applied selectively to the subset of patients with indeterminate noninvasive localization studies.
Between January 1990 and December 2001, 64 of 235 (27%) patients with persistent or recurrent hyperparathyroidism were considered candidates for SVS in addition to noninvasive localization studies. Accuracy of SVS for PTH was retrospectively evaluated.
Successful surgical treatment was achieved in 86% of these patients. SVS for PTH yielded true-positive results in 75% of patients and was not useful for the surgeon in 17% (completely false-positive in 12% and indeterminate in 5%). In 2% of patients, SVS identified successfully 1 gland but failed to locate another abnormal gland. In 6% of patients, the location of the abnormal parathyroid tissue remained unknown, and the patients have persistent hyperparathyroidism.
We showed that SVS is clinically useful in patients with persistent or recurrent hyperparathyroidism when the noninvasive localization studies do not clearly localize the abnormal parathyroid glands.
颈部和纵隔的术前无创定位研究对再次手术有益。然而，选择性静脉采血（SVS）检测甲状旁腺激素（PTH）在再次甲状旁腺手术中的作用尚未明确界定。本研究的目的是评估选择性应用于无创定位研究结果不确定的患者亚组时SVS的准确性。
1990年1月至2001年12月期间，235例持续性或复发性甲状旁腺功能亢进患者中有64例（27%）除无创定位研究外还被认为适合进行SVS。对SVS检测PTH的准确性进行回顾性评估。
这些患者中有86%获得了成功的手术治疗。SVS检测PTH在75%的患者中产生了真阳性结果，对手术医生没有帮助的占17%（12%为完全假阳性，5%为结果不确定）。2%的患者中，SVS成功识别出1个腺体，但未能定位另一个异常腺体。6%的患者中，异常甲状旁腺组织的位置仍然未知，这些患者仍患有持续性甲状旁腺功能亢进。
我们表明，当无创定位研究不能明确定位异常甲状旁腺时，SVS对持续性或复发性甲状旁腺功能亢进患者具有临床实用性。
