Quiros Roderick M, Valentin Carl, DeCresce Robert, Prinz Richard A
Department of General Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612-6833, USA.
J Surg Res. 2003 Sep;114(1):57-63. doi: 10.1016/s0022-4804(03)00206-3.
Intraoperative intact parathyroid hormone (iPTH) monitoring is useful in the operative management of hyperparathyroidism. Recent studies suggest that measurement of intraoperative total serum calcium (TSC) levels may be a more cost effective and readily available method of intraoperative guidance during neck dissection than iPTH levels, the gold standard. We compared the accuracy of intraoperative TSC to iPTH in predicting surgical cure during parathyroidectomy.
From September 1, 2001 to October 31, 2002, 88 parathyroidectomies were performed. iPTH and TSC were measured at the start of the operation, and at 5 and 10 min after gland removal. Data were compared, and trends were analyzed with respect to removal of abnormal parathyroid tissue as confirmed by pathology. One-way analysis of variance was used to determine if decreases in TSC were significant.
The mean baseline iPTH level (418 +/- 610 pg/ml) dropped by 70% 5 min after removal of the abnormal glands (86 +/- 102 pg/ml) and by 85% at 10 min (39 +/- 39 pg/ml). The mean baseline TSC level (10.0 +/- 0.8 mg/dl) dropped by 4% at 5 min after removal of the abnormal glands (9.6 +/- 0.9 mg/dl) and remained at 4% at 10 min (9.6 +/- 0.8 mg/dl). iPTH dropped by > or =50% in 73 patients (83%) at 5 min and in 87 patients (99%) at 10 min after gland resection. TSC decreased below baseline at 5 min and remained below baseline at 10 min in only 47 patients (54%). In the remaining patients, intraoperative TSC changes were less predictable and did not respond consistently to resection of abnormal glands.
The decreases in TSC during parathyroidectomy, if present, are minimal. Unlike iPTH levels, TSC levels do not consistently decrease at 5 and 10 min after gland resection. While attractive in terms of cost and availability, intraoperative TSC levels are not clinically reliable in confirming removal of abnormal parathyroid tissue.
术中完整甲状旁腺激素（iPTH）监测在甲状旁腺功能亢进的手术治疗中很有用。最近的研究表明，与作为金标准的iPTH水平相比，术中测量总血清钙（TSC）水平可能是一种在颈部解剖术中更具成本效益且更易于获得的术中指导方法。我们比较了术中TSC与iPTH在预测甲状旁腺切除术中手术治愈方面的准确性。
2001年9月1日至2002年10月31日期间，共进行了88例甲状旁腺切除术。在手术开始时以及腺体切除后5分钟和10分钟测量iPTH和TSC。对数据进行比较，并根据病理证实的异常甲状旁腺组织切除情况分析趋势。采用单因素方差分析来确定TSC的下降是否显著。
异常腺体切除后5分钟，平均基线iPTH水平（418±610 pg/ml）下降了70%（86±102 pg/ml），10分钟时下降了85%（39±39 pg/ml）。异常腺体切除后5分钟，平均基线TSC水平（10.0±0.8 mg/dl）下降了4%（9.6±0.9 mg/dl），10分钟时仍为4%（9.6±0.8 mg/dl）。腺体切除后5分钟，73例患者（83%）的iPTH下降≥50%，10分钟时87例患者（99%）的iPTH下降≥50%。仅47例患者（54%）的TSC在5分钟时降至基线以下，10分钟时仍低于基线。在其余患者中，术中TSC变化较难预测，对异常腺体切除的反应也不一致。
甲状旁腺切除术中TSC的下降（如果存在）是最小的。与iPTH水平不同，TSC水平在腺体切除后5分钟和10分钟时并非持续下降。虽然在成本和可获得性方面具有吸引力，但术中TSC水平在确认异常甲状旁腺组织切除方面在临床上并不可靠。
