Chen Herbert, Mack Eberhard, Starling James R
University of Wisconsin Medical School Department of Surgery, H4/750 CSC 600 Highland Avenue, Madison, WI, USA.
Ann Surg. 2003 Sep;238(3):332-7; discussion 337-8. doi: 10.1097/01.sla.0000086546.68794.9a.
To determine the utility of radioguided parathyroidectomy for patients with hyperparathyroidism, we studied the properties of 180 resected, hyperfunctioning parathyroid glands.
Radioguided resection of hyperfunctioning parathyroid glands has been shown to be technically feasible in patients with parathyroid adenomas. Radioguided excision may obviate the need for intraoperative frozen section because excised parathyroid adenomas uniformly have radionuclide ex vivo counts >20% of background. The feasibility and applicability of radioguided techniques for patients with parathyroid hyperplasia are unclear.
Between March 2001 and September 2002, 102 patients underwent neck exploration for primary (n = 77) and secondary/tertiary (n = 25) hyperparathyroidism. All patients received an injection of 10 mCi of Tc-99m sestamibi the day of surgery. Using a gamma probe, intraoperative scanning was performed, looking for in vivo radionuclide counts > background to localize abnormal parathyroid glands. After excision, radionuclide counts of each ex vivo parathyroid gland were determined and expressed as a percentage of background counts.RESULTS Although patients with single adenomas had higher mean background radionuclide counts, the average in vivo counts of all enlarged glands were higher than background. Notably, in vivo counts did not differ between adenomatous and hyperplastic glands, suggesting equal sensitivity for intraoperative gamma detection. Ectopically located glands were identified in 22 cases and all were accurately localized using the gamma probe. Postresection, mean ex vivo radionuclide counts were highest in the single parathyroid adenomas and lowest in hyperplastic glands. Importantly, in all hyperplastic glands, the ex vivo counts were >20%.
In patients with hyperparathyroidism, radioguided surgery is a sensitive adjunct for the intraoperative localization of both adenomatous and hyperplastic glands. In this series, all 180 enlarged parathyroids were located with the gamma probe. We have also shown that the ">20% rule" for ex vivo counts not only applies to parathyroid adenomas but also to hyperplastic glands. Therefore, radioguided resection is equally effective and informative for both adenomatous and hyperplastic glands.
为了确定放射性引导甲状旁腺切除术对甲状旁腺功能亢进患者的效用，我们研究了180个切除的功能亢进甲状旁腺的特性。
放射性引导切除功能亢进的甲状旁腺已被证明在甲状旁腺腺瘤患者中技术上是可行的。放射性引导切除可能无需术中冰冻切片，因为切除的甲状旁腺腺瘤放射性核素体外计数均大于背景值的20%。放射性引导技术对甲状旁腺增生患者的可行性和适用性尚不清楚。
在2001年3月至2002年9月期间，102例患者因原发性（n = 77）和继发性/三发性（n = 25）甲状旁腺功能亢进接受颈部探查。所有患者在手术当天注射10 mCi的锝-99m甲氧基异丁基异腈。使用γ探测器进行术中扫描，寻找体内放射性核素计数大于背景值以定位异常甲状旁腺。切除后，测定每个体外甲状旁腺的放射性核素计数，并表示为背景计数的百分比。
尽管单发性腺瘤患者的平均背景放射性核素计数较高，但所有增大腺体的平均体内计数均高于背景值。值得注意的是，腺瘤性和增生性腺体的体内计数没有差异，表明术中γ探测的敏感性相同。22例患者发现异位腺体，所有这些腺体均使用γ探测器准确定位。切除后，单个甲状旁腺腺瘤的平均体外放射性核素计数最高，增生性腺体最低。重要的是，在所有增生性腺体中，体外计数均大于20%。
在甲状旁腺功能亢进患者中，放射性引导手术是腺瘤性和增生性腺体术中定位的敏感辅助手段。在本系列中，所有180个增大的甲状旁腺均通过γ探测器定位。我们还表明，体外计数的“>20%规则”不仅适用于甲状旁腺腺瘤，也适用于增生性腺体。因此，放射性引导切除对腺瘤性和增生性腺体同样有效且提供信息丰富。
