Farley David R
Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
World J Surg. 2004 Dec;28(12):1207-11. doi: 10.1007/s00268-004-7639-2. Epub 2004 Nov 4.
As refinement of technetium-99m 2-methoxyisobutyl isonitrile-scintigraphy (MIBI)-scintigraphy of parathyroid glands has continued since its initial use in 1989, the sensitivity, specificity, and overall accuracy of the technique have improved greatly, approaching 100% for larger, solitary adenomas. Preoperative use of sestamibi scintigraphy has become commonplace and allows surgeons the option of a minimally invasive, or focused approach for their patients with primary hyperparathyroidism. Intraoperative use of the gamma probe based on sestamibi localization has not caught on due to lesser accuracy, cumbersome gamma probes, small doses of radiation exposure for patients and staff, and the greater accuracy and current confidence in intraoperative parathormone (PTH) monitoring. However, with the potential for smaller and more accurate gamma probes that truly assist in localizing abnormal parathyroid glands, the potential for cost reduction by shortening operative times, avoiding expensive PTH assays, and eliminating the need for pathologic analysis, gamma scintigraphy may yet become a viable option for many parathyroid surgeons.
自1989年首次使用以来，随着甲状旁腺的锝-99m甲氧基异丁基异腈闪烁扫描术（MIBI）扫描技术不断完善，该技术的敏感性、特异性和总体准确性有了很大提高，对于较大的孤立性腺瘤，其准确率接近100%。术前使用甲氧基异丁基异腈闪烁扫描术已变得很普遍，这使外科医生能够为原发性甲状旁腺功能亢进患者选择微创或聚焦手术方式。基于甲氧基异丁基异腈定位的术中γ探测仪由于准确性较低、γ探测仪操作不便、患者和工作人员受到的辐射剂量小以及术中甲状旁腺激素（PTH）监测的准确性更高且目前更受信赖，因而未流行起来。然而，随着可能出现更小、更准确且真正有助于定位异常甲状旁腺的γ探测仪，通过缩短手术时间、避免昂贵的PTH检测以及无需病理分析来降低成本，γ闪烁扫描术可能会成为许多甲状旁腺外科医生可行的选择。
