Rubello Domenico, Casara Dario, Giannini Sandro, Piotto Andrea, Dalle Carbonare Luca, Pagetta Costantino, Boni Giuseppe, Mariani Giuliano, Muzzio Pier Carlo, Pelizzo Maria Rosa
Nuclear Medicine Service, S. Maria della Misericordia Rovigo Hospital, Azienda ULSS 18 Rovigo, Istituto Oncologico Veneto, Viale Tre Martiri 140, 45100 Rovigo, Italy.
Nucl Med Commun. 2004 Sep;25(9):901-8. doi: 10.1097/00006231-200409000-00007.
Surgery for primary hyperparathyroidism (PHPT) due to a solitary parathyroid adenoma (PA) is moving from traditional bilateral neck exploration (BNE) towards the use of limited neck exploration. The aim of the present study was to define the efficacy of minimally invasive radioguided surgery (MIRS) in PHPT patients with a high probability of a solitary PA with particular regard to benefits achievable in elderly patients.
The study population included a total of 266 consecutive PHPT patients who had undergone surgery at our centre between September 1999 and February 2003. Preoperative imaging consisted of [Tc]pertechnetate/Tc sestamibi (TcO4/sestamibi) scintigraphy and neck ultrasound obtained in the same session. One hundred and eighty-seven patients from the whole series (75 of whom were older than 65 years) with a high scan/ultrasound probability of a solitary PA, a high PA sestamibi uptake, and a normal thyroid gland were selected for MIRS. The other 79 patients were selected for traditional BNE. The intra-operative technique was based on the injection of a low dose (37 MBq) of sestamibi in the operating theatre a few minutes before the beginning of intervention and on the use of an 11 mm collimated gamma probe.
MIRS was successfully performed in 97.8% of all PHPT patients selected for this type of surgery and, in particular, in 100% of the subgroup (n=75) of elderly patients. MIRS required a mean operating time of 35 min and a mean hospital stay of 1.2 days; that is, approximately half of that required for traditional BNE. Moreover, local anaesthesia was successfully performed in 27 patients, 19 of whom were >65 years with concomitant invalidating diseases contraindicating general anaesthesia. No major surgical complications were recorded. Transitory hypocalcaemia was observed in 9% of cases treated with MIRS compared with 27% of patients treated with BNE.
MIRS can be accurately planned in elderly PHPT patients with a solitary PA on the basis of a TcO4/sestamibi scan and neck ultrasound. MIRS has been proven to be safe and effective in our experience, and allows a significant reduction of operating and recovery time, as well as the possibility of using local anaesthesia, especially in elderly patients with concomitant invalidating diseases.
因单发甲状旁腺腺瘤（PA）导致的原发性甲状旁腺功能亢进症（PHPT）的手术方式正从传统的双侧颈部探查（BNE）转向有限颈部探查。本研究的目的是确定微创放射性引导手术（MIRS）在高度疑似单发PA的PHPT患者中的疗效，尤其关注老年患者可获得的益处。
研究人群包括1999年9月至2003年2月期间在本中心接受手术的266例连续PHPT患者。术前影像学检查包括在同一时段进行的[锝]高锝酸盐/锝甲氧基异丁基异腈（TcO4/甲氧基异丁基异腈）闪烁扫描和颈部超声检查。从整个系列中选取187例患者（其中75例年龄超过65岁），这些患者扫描/超声高度疑似单发PA、PA甲氧基异丁基异腈摄取高且甲状腺正常，进行MIRS。另外79例患者选择进行传统BNE。术中技术基于在干预开始前几分钟在手术室注射低剂量（37 MBq）的甲氧基异丁基异腈，并使用11毫米准直伽马探头。
在所有选择此类手术的PHPT患者中，97.8%成功进行了MIRS，特别是在老年患者亚组（n = 75）中成功率为100%。MIRS的平均手术时间为35分钟，平均住院时间为1.2天；即约为传统BNE所需时间的一半。此外，27例患者成功进行了局部麻醉，其中19例年龄>65岁且伴有不宜全身麻醉的致残性疾病。未记录到重大手术并发症。MIRS治疗的病例中有9%出现短暂性低钙血症，而BNE治疗的患者中有27%出现该情况。
基于TcO4/甲氧基异丁基异腈扫描和颈部超声检查，可准确地为患有单发PA的老年PHPT患者规划MIRS。根据我们的经验，MIRS已被证明是安全有效的，并且可显著缩短手术和恢复时间，还可使用局部麻醉，尤其是对于伴有致残性疾病的老年患者。
