Gawande Atul A, Monchik Jack M, Abbruzzese Thomas A, Iannuccilli Jason D, Ibrahim Shahrul I, Moore Francis D
Harvard School of Public Health, Boston, MA, USA.
Arch Surg. 2006 Apr;141(4):381-4; discussion 384. doi: 10.1001/archsurg.141.4.381.
For patients with primary hyperparathyroidism and patients with 2 localization studies showing the same single location of parathyroid disease, use of intraoperative parathyroid hormone (IOPTH) measurement does not significantly increase the success of minimally invasive parathyroidectomy.
Retrospective cohort study.
Experience of 2 academic centers over 5 years (at Brigham and Women's Hospital, Boston, Mass) and almost 4 years (at Rhode Island Hospital, Providence).
A total of 569 patients with primary hyperparathyroidism who underwent technetium Tc 99m sestamibi (MIBI) parathyroid imaging and neck ultrasonography (US).
Incidence of correct prediction of location and extent of disease.
In 322 patients (57%), MIBI and US imaging identified the same single site of disease. In 319 (99%) of these 322 patients, surgical exploration confirmed a parathyroid adenoma at that site, and the IOPTH levels normalized on removal. In 3 (1%) of the 322 patients, IOPTH measurement identified unsuspected additional disease. In 3 (1%) of the remaining 319 patients, IOPTH-guided removal of a single adenoma failed to correct hypercalcemia. Therefore, the failure rate of surgery in patients with positive MIBI and positive US imaging was 1% with IOPTH measurement and 2% without IOPTH measurement (P = .50). In 201 (35%) of the 569 patients, only 1 of the 2 studies recognized an abnormality or the studies disagreed on location. In these cases, either MIBI imaging or US imaging (if MIBI imaging was negative) failed to predict the correct site or extent of disease in 76 (38%) of the 201 patients (P<.001 vs concordant studies).
In primary hyperparathyroidism, concordant preoperative localization with MIBI and US imaging is highly accurate. Use of IOPTH measurement in these cases adds only marginal benefit. When only 1 of the 2 studies identifies disease or the studies conflict, however, IOPTH measurement remains essential during minimally invasive parathyroidectomy.
对于原发性甲状旁腺功能亢进患者以及两项定位研究显示甲状旁腺疾病位于同一单一部位的患者，术中甲状旁腺激素（IOPTH）测量的应用并不会显著提高微创甲状旁腺切除术的成功率。
回顾性队列研究。
两所学术中心分别为5年（位于马萨诸塞州波士顿的布里格姆妇女医院）和近4年（位于普罗维登斯的罗德岛医院）的经验。
共有569例原发性甲状旁腺功能亢进患者接受了锝Tc 99m甲氧基异丁基异腈（MIBI）甲状旁腺显像及颈部超声检查（US）。
疾病位置及范围预测正确的发生率。
在322例患者（57%）中，MIBI和US显像确定了相同的单一疾病部位。在这322例患者中的319例（99%），手术探查证实该部位有甲状旁腺腺瘤，切除后IOPTH水平恢复正常。在322例患者中的3例（1%），IOPTH测量发现了未被怀疑的其他疾病。在其余319例患者中的3例（1%），IOPTH引导下切除单一腺瘤未能纠正高钙血症。因此，MIBI和US显像均为阳性的患者，使用IOPTH测量时手术失败率为1%，未使用IOPTH测量时为2%（P = 0.50）。在569例患者中的201例（35%），两项研究中只有一项发现异常或两项研究在位置上存在分歧。在这些病例中，MIBI显像或US显像（如果MIBI显像为阴性）在201例患者中的76例（38%）未能预测正确的疾病部位或范围（与一致性研究相比，P<0.001）。
在原发性甲状旁腺功能亢进中，MIBI和US显像术前定位一致具有高度准确性。在这些病例中使用IOPTH测量仅增加了边际效益。然而，当两项研究中只有一项发现疾病或两项研究存在冲突时，在微创甲状旁腺切除术中IOPTH测量仍然至关重要。
