Rubello D, Giannini S, De Carlo E, Mariani G, Muzzio P C, Rampin L, Pelizzo M R
Nuclear Medicine Service, Rovigo Hospital, Rovigo, Italy.
Panminerva Med. 2005 Jun;47(2):99-107.
In the last 10 to 15 years surgery of primary hyperparathyroidism (PHPT) moved from the wide bilateral neck exploration to various types of limited neck exploration ranging from unilateral neck surgery to minimally invasive approaches as the minimally invasive radioguided parathyroidectomy. In contrast with the bilateral neck exploration, an accurate preoperative localizing imaging, which is mainly based on (99m)TC-sestamibi scintigraphy, is mandatory when planning a concise parathyroidectomy. Following imaging criteria, only a fraction of PHPT patients accounting for approximately 60% to 70% of all PHPT patients can be eligible for a minimally invasive parathyroidectomy. Only PHPT patients with a high probability to be affected by a solitary parathyroid adenoma showing a high (99m)TC-sestamibi uptake and with a normal thyroid gland should be offer a minimally invasive radioguided parathyroidectomy. The (99m)TC-sestamibi SPECT technique and the double-tracer 123-iodine or (99m)TC-pertecnetate/(99m)TC-sestamibi scintigraphic technique are the most sensitive and accurate preoperative imaging modalities and their utilization is recommended when considering a minimally invasive radioguided parathyroidectomy. Two main intraoperative procedures for the minimally invasive radioguided surgery have been described: the single-day protocol and the different-day protocol. In the single-day protocol a 740 MBq dose of (99m)TC-sestamibi is injected to the patient, scintigraphic imaging is obtained by dual-phase technique and then the patient is operated on within approximately 3 hours from radio-tracer injection. In the different-day protocol, a double-tracer parathyroid scintigraphy is obtained some days before surgery with the aim of better planning the type and extension of intervention. The day of intervention, for the purpose of radioguided surgery only, a low 37 MBq dose of (99m)TC-sestamibi is injected to the patient in the operating theatre a few minutes before the start of intervention. The main advantages of minimally invasive radioguided parathyroidectomy over the traditional wide bilateral neck exploration can be resumed as follows: a shortening in the operating and recovery time, possibility of local anesthesia, possibility of ambulatory surgery or same-day discharge, less postsurgical hypocalcemia, less postsurgical pain, favourable cosmetic results, benefits from a cost-analysis point of view.
在过去10到15年中，原发性甲状旁腺功能亢进症（PHPT）的手术方式已从广泛的双侧颈部探查转变为各种类型的有限颈部探查，范围从单侧颈部手术到微创方法，如微创放射性引导甲状旁腺切除术。与双侧颈部探查不同，在计划进行简洁的甲状旁腺切除术时，准确的术前定位成像（主要基于（99m）锝-司他米比闪烁扫描）是必不可少的。根据成像标准，只有约占所有PHPT患者60%至70%的一部分PHPT患者适合进行微创甲状旁腺切除术。只有高度可能患有单个甲状旁腺腺瘤且显示出高（99m）锝-司他米比摄取且甲状腺正常的PHPT患者才应接受微创放射性引导甲状旁腺切除术。（99m）锝-司他米比SPECT技术以及双示踪剂123-碘或（99m）锝-高锝酸盐/（99m）锝-司他米比闪烁扫描技术是最敏感和准确的术前成像方式，在考虑进行微创放射性引导甲状旁腺切除术时建议使用。已经描述了微创放射性引导手术的两种主要术中操作方案：单日方案和不同日方案。在单日方案中，向患者注射740MBq剂量的（99m）锝-司他米比，通过双相技术获得闪烁扫描图像，然后在注射放射性示踪剂后约3小时内对患者进行手术。在不同日方案中，在手术前几天进行双示踪剂甲状旁腺闪烁扫描，目的是更好地规划干预的类型和范围。在干预当天，仅为了放射性引导手术，在手术开始前几分钟在手术室向患者注射低剂量37MBq的（99m）锝-司他米比。微创放射性引导甲状旁腺切除术相对于传统的广泛双侧颈部探查的主要优点可以总结如下：手术和恢复时间缩短、可进行局部麻醉、可进行日间手术或当日出院、术后低钙血症较少、术后疼痛较轻、美容效果良好、从成本分析角度来看有好处。
