Wild Jeffrey L, Weigel Tracey, Chen Herbert
Department of Surgery, University of Wisconsin, Madison, WI 53792, USA.
Clin Nucl Med. 2006 Jan;31(1):9-12. doi: 10.1097/01.rlu.0000192133.01825.77.
We report on a patient with primary hyperparathyroidism (1HPT) who had a preoperative Tc-99m sestamibi scan localizing a single parathyroid adenoma in the mediastinum.
On removal of this hyperfunctioning adenoma by radioguided video-assisted thoracoscopic surgery (VATS), intraoperative PTH levels failed to decline in the appropriate manner consistent with curative resection. This prompted the surgical team to investigate further for a second adenoma, which revealed a 2 x 1-cm mass near the inferior border of the thyroid gland on the right lateral aspect of the trachea.
In the absence of intraoperative PTH monitoring, the operation would have been terminated after the removal of the mediastinal adenoma, leading to an incomplete surgical resection and persistent 1HPT.
In our patient, curative resection was obtained and a second operation was avoided because of the use of intraoperative PTH monitoring. This case also emphasizes that although VATS was planned, in treating patients with 1HPT, one must also be prepared to perform a neck exploration.
我们报告一例原发性甲状旁腺功能亢进症（1HPT）患者，其术前Tc-99m 甲氧基异丁基异腈扫描定位出纵隔内有一个甲状旁腺腺瘤。
通过放射性引导电视辅助胸腔镜手术（VATS）切除这个功能亢进的腺瘤时，术中甲状旁腺激素（PTH）水平未按与根治性切除相符的适当方式下降。这促使手术团队进一步探查是否存在第二个腺瘤，结果在气管右侧甲状腺下缘附近发现一个2×1厘米的肿物。
若术中未进行PTH监测，在切除纵隔腺瘤后手术就会终止，导致手术切除不完全及持续性1HPT。
在我们的患者中，由于使用了术中PTH监测，实现了根治性切除并避免了二次手术。该病例还强调，尽管计划采用VATS，但在治疗1HPT患者时，也必须做好进行颈部探查的准备。
