Lo C-Y, Chan W F, Luk J M
Department of Surgery, The University of Hong Kong Medical Center, Queen Mary Hospital, Division of Endocrine Surgery, Pokfulam Road, Hong Kong, China.
Surg Endosc. 2003 Dec;17(12):1932-6. doi: 10.1007/s00464-003-9072-2. Epub 2003 Oct 28.
Minimally invasive surgery for primary hyperparathyroidism (pHPT) depends on both an accurate preoperative localization and the availability of intraoperative parathyroid hormone monitoring.
Patients with sporadic pHPT and one unequivocally enlarged parathyroid gland on preoperative imaging underwent endoscopic-assisted parathyroidectomy. Intraoperative rapid parathyroid hormone (quick PTH) monitoring was performed, and surgical success was confirmed when there was a >50% decrease in quick PTH level 10 min after excision as compared with the baseline level at induction. The surgical outcome and the use of preoperative localization, together with the role played by quick PTH assay in enhancing the operative success, were evaluated.
From 1999 to 2002, 66 of 107 patients (62%) were selected for this approach. The accuracy of 99mTc-Sestamibi scintigraphy and ultrasonography was 97% and 70%, respectively. Conversion was required in four cases due to technical problems, and four additional patients failed to show a significant decline in quick PTH levels postexcision. Two patients underwent cervical exploration without the finding of any additional pathology, and another two patients had a delayed drop in quick PTH that was confirmed 30 min postexcision. All patients had a solitary adenoma and were cured of hypercalcemia during a median follow-up of 9 months.
Minimally invasive endoscopic-assisted parathyroidectomy can be performed expeditiously in a select group of patients based on 99mTc-Sestamibi scintigraphy. The use of quick PTH assay can ensure surgical success, but careful interpretation of the results is mandatory.
原发性甲状旁腺功能亢进症（pHPT）的微创手术取决于术前的精确定位以及术中甲状旁腺激素监测的可行性。
对术前影像学检查发现有一个明确增大的甲状旁腺的散发性pHPT患者进行内镜辅助甲状旁腺切除术。术中进行快速甲状旁腺激素（快速PTH）监测，当切除后10分钟时快速PTH水平与诱导时的基线水平相比下降>50%时，确认手术成功。评估手术结果、术前定位的使用情况以及快速PTH检测在提高手术成功率中所起的作用。
1999年至2002年，107例患者中有66例（62%）被选用于此方法。99mTc-甲氧基异丁基异腈闪烁扫描和超声检查的准确率分别为97%和70%。4例因技术问题需要中转手术，另外4例患者切除后快速PTH水平未出现显著下降。2例患者进行了颈部探查，未发现其他病变，另外2例患者切除后快速PTH水平延迟下降，在切除后30分钟得到确认。所有患者均有一个孤立性腺瘤，在中位随访9个月期间高钙血症均得到治愈。
基于99mTc-甲氧基异丁基异腈闪烁扫描，可在特定患者群体中快速进行微创内镜辅助甲状旁腺切除术。快速PTH检测的使用可确保手术成功，但必须仔细解读结果。
