Mariani Giuliano, Gulec Seza A, Rubello Domenico, Boni Giuseppe, Puccini Marco, Pelizzo Maria Rosa, Manca Gianpiero, Casara Dario, Sotti Guido, Erba Paola, Volterrani Duccio, Giuliano Armando E
Regional Center of Nuclear Medicine, University of Pisa Medical School, Pisa, Italy.
J Nucl Med. 2003 Sep;44(9):1443-58.
Clinical or subclinical hyperparathyroidism is one of the most common endocrine disorders. Excessive secretion of parathyroid hormone is most frequently caused by an adenoma of >or=1 parathyroid gland. Unsuccessful surgery with persistent hyperparathyroidism, due to inadequate preoperative or intraoperative localization, may be observed in about 10% of patients. The conventional surgical approach is bilateral neck exploration, whereas minimally invasive parathyroidectomy (MIP) has been made possible by the introduction of (99m)Tc-sestamibi scintigraphy for preoperative localization of parathyroid adenomas. In MIP, the incision is small, dissection is minimal, postoperative pain is less, and hospital stay is shorter. Localization imaging techniques include ultrasonography, CT, MRI, and scintigraphy. Parathyroid scintigraphy with (99m)Tc-sestamibi is based on longer retention of the tracer in parathyroid than in thyroid tissue. Because of the frequent association of parathyroid adenomas with nodular goiter, the optimal imaging combination is (99m)Tc-sestamibi scintigraphy and ultrasonography. Different protocols are used for (99m)Tc-sestamibi parathyroid scintigraphy, depending on the institutional logistics and experience (classical dual-phase scintigraphy, various subtraction techniques in combination with radioiodine or (99m)Tc-pertechnetate). MIP is greatly aided by intraoperative guidance with a gamma-probe, based on in vivo radioactivity counting after injection of (99m)Tc-sestamibi. Different protocols used for gamma-probe-guided MIP are based on different timing and doses of tracer injected. Gamma-probe-guided MIP is a very attractive surgical approach to treat patients with primary hyperparathyroidism due to a solitary parathyroid adenoma. The procedure is technically easy, safe, with a low morbidity rate, and has better cosmetic results and lower overall cost than conventional bilateral neck exploration. Specific guidelines should be followed when selecting patients for gamma-probe-guided MIP.
临床或亚临床甲状旁腺功能亢进是最常见的内分泌疾病之一。甲状旁腺激素分泌过多最常见的原因是一个或多个甲状旁腺腺瘤。由于术前或术中定位不准确，约10%的患者手术失败且甲状旁腺功能亢进持续存在。传统的手术方法是双侧颈部探查，而引入（99m）锝-甲氧基异丁基异腈闪烁扫描术用于术前甲状旁腺腺瘤定位后，微创甲状旁腺切除术（MIP）成为可能。在MIP中，切口小，解剖范围小，术后疼痛轻，住院时间短。定位成像技术包括超声检查、CT、MRI和闪烁扫描术。（99m）锝-甲氧基异丁基异腈甲状旁腺闪烁扫描术基于示踪剂在甲状旁腺中的滞留时间比在甲状腺组织中长。由于甲状旁腺腺瘤常与结节性甲状腺肿相关，最佳的成像组合是（99m）锝-甲氧基异丁基异腈闪烁扫描术和超声检查。根据机构的后勤保障和经验，（99m）锝-甲氧基异丁基异腈甲状旁腺闪烁扫描术采用不同的方案（经典双期闪烁扫描术、与放射性碘或（99m）锝-高锝酸盐联合的各种减影技术）。注射（99m）锝-甲氧基异丁基异腈后基于体内放射性计数的γ探头术中引导极大地辅助了MIP。用于γ探头引导的MIP的不同方案基于注射示踪剂的不同时间和剂量。γ探头引导的MIP是治疗因孤立性甲状旁腺腺瘤导致的原发性甲状旁腺功能亢进患者的一种非常有吸引力的手术方法。该手术在技术上简单、安全，发病率低，与传统双侧颈部探查相比具有更好的美容效果和更低的总成本。选择接受γ探头引导的MIP的患者时应遵循特定的指南。
