Kitagawa Wataru, Shimizu Kazuo, Akasu Haruki
Division of Endocrine Surgery, Department of Surgery II, Nippon Medical School, Tokyo, Japan.
Med Sci Monit. 2003 Jun;9(6):CS53-6.
Minimally invasive radioguided parathyroidectomy (MIRP) offers several cosmetic and surgical advantages. Intraoperative 99m-Tc sestamibi scintigraphy using a solid-state, multi-crystal gamma camera was used to perform the MIRP. We report a case of primary hyperparathyroidism treated with this surgical procedure and discuss the usefulness of intraoperative scintigraphy.
The patient was a 58-year-old Japanese woman was given a diagnosis of primary hyperparathyroidism. One hour before the operation, 99m-Tc sestamibi was injected intravenously and scintigraphy was performed in the operating room before the skin incision. Sestamibi imaging revealed an abnormal uptake close to the lower right lobe of the thyroid gland and MIRP was performed. After the tumor behind the right recurrent laryngeal nerve close to the lower right lobe of the thyroid gland was removed, intraoperative scintigraphy still revealed an abnormal uptake. MIRP was continued and an abnormal parathyroid gland behind the right carotid artery near the right recurrent laryngeal nerve was identified. After removing a parathyroid adenoma from this second location, intraoperative sestamibi imaging revealed no abnormal uptake.
The operation time was 80 minutes and the amount of bleeding was 12 ml. Postoperatively, serum calcium and PTH levels were within normal range. No complications were observed.
Intraoperative sestamibi imaging using a portable gamma camera is useful for locating abnormal parathyroid glands.
微创放射性引导甲状旁腺切除术（MIRP）具有若干美容和手术方面的优势。使用固态多晶体γ相机进行术中99m锝-甲氧基异丁基异腈闪烁扫描以实施MIRP。我们报告一例采用该手术方法治疗原发性甲状旁腺功能亢进症的病例，并讨论术中闪烁扫描的实用性。
该患者为一名58岁的日本女性，被诊断为原发性甲状旁腺功能亢进症。手术前一小时，静脉注射99m锝-甲氧基异丁基异腈，并在皮肤切口前在手术室进行闪烁扫描。甲氧基异丁基异腈成像显示甲状腺右下叶附近有异常摄取，遂进行MIRP。在切除靠近甲状腺右下叶的右侧喉返神经后方的肿瘤后，术中闪烁扫描仍显示有异常摄取。继续进行MIRP，在右侧喉返神经附近的右颈动脉后方发现一个异常甲状旁腺。从这个第二个位置切除甲状旁腺腺瘤后，术中甲氧基异丁基异腈成像未显示异常摄取。
手术时间为80分钟，出血量为12毫升。术后，血清钙和甲状旁腺激素水平在正常范围内。未观察到并发症。
使用便携式γ相机进行术中甲氧基异丁基异腈成像有助于定位异常甲状旁腺。
