Carter Alexis Byrne, Howanitz Peter J
Department of Pathology & Laboratory Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
Arch Pathol Lab Med. 2003 Nov;127(11):1424-42. doi: 10.5858/2003-127-1424-ITFPHA.
The rapid intraoperative parathyroid hormone assay is transforming the parathyroidectomy procedure. We present a review of the literature on the use of the assay as an adjunct to surgery. To our knowledge, this is the first review of the literature to encompass and compare all known primary studies of this assay in parathyroidectomy patients.
Articles were collected by searching MEDLINE databases using relevant terminology. The references of these articles were reviewed for additional studies. Supplementary articles pertinent to the parathyroidectomy procedure, preoperative parathyroid localization studies, and intraoperative parathyroid hormone assay development also were examined.
One hundred sixty-five references were analyzed and categorized separately into groups.
The primary studies of intraoperative data on patients undergoing parathyroidectomy were compared when possible. Studies were analyzed by type of assay used, where performed, turnaround time, and efficiency of use. Reviews of the types of parathyroid surgery and preoperative localization were included for educational purposes.Conclusions.-The intraoperative parathyroid hormone assay is a useful adjunct to preoperative imaging and parathyroid surgery because of its unique ability to detect an occult residuum of hyperfunctioning parathyroid tissue. Use of this assay will obviate the need for frozen section in most routine cases. The test facilitates minimally invasive parathyroidectomy for single parathyroid adenomas, which, in turn, improves cost-effectiveness and cosmetic outcome. Its use in patients with known preoperative multiglandular disease is promising but requires further study.
术中快速甲状旁腺激素测定正在改变甲状旁腺切除术的术式。我们对有关该测定作为手术辅助手段应用的文献进行综述。据我们所知，这是首次对涉及并比较甲状旁腺切除术患者中该测定所有已知的主要研究的文献进行综述。
通过使用相关术语检索MEDLINE数据库收集文章。对这些文章的参考文献进行审查以寻找其他研究。还查阅了与甲状旁腺切除术、术前甲状旁腺定位研究以及术中甲状旁腺激素测定发展相关的补充文章。
对165篇参考文献进行分析并分别分组。
尽可能对甲状旁腺切除术患者术中数据的主要研究进行比较。根据所使用的测定类型、进行测定的地点、周转时间和使用效率对研究进行分析。为了便于理解，纳入了甲状旁腺手术类型和术前定位的综述。
术中甲状旁腺激素测定是术前成像和甲状旁腺手术的有用辅助手段，因为它具有独特的能力来检测功能亢进的甲状旁腺组织的隐匿残留。在大多数常规病例中，使用该测定将无需进行冰冻切片。该检测有助于对单个甲状旁腺腺瘤进行微创甲状旁腺切除术，进而提高成本效益和美容效果。其在术前已知有多腺体疾病的患者中的应用前景良好，但需要进一步研究。
