Irvin G L, Dembrow V D, Prudhomme D L
Department of Surgery, University of Miami School of Medicine, Florida.
Am J Surg. 1991 Oct;162(4):299-302. doi: 10.1016/0002-9610(91)90135-z.
With a 20-year experience of more than 700 parathyroidectomies, our persistent hypercalcemic postoperative failure rate of 7% has remained constant. Reasons for failure have been misdiagnosis or inability of the surgeon to detect and excise all hypersecreting glands. We have modified a commercially available immunoradiometric assay for intact parathyroid hormone (PTH) resulting in a 15-minute turnaround time. Since intact PTH has a half-life measured in minutes, whole blood samples taken 10 minutes after gland excisions were monitored intraoperatively to confirm significant changes in circulating hormone. Quantitative evidence that all hyperfunctioning parathyroid tissue had been ablated during operation was obtained in 19 of 21 patients. Less than four glands each were identified in 53% of these patients. The PTH "quick" test correctly pointed to an inadequate excision requiring further parathyroid ablation in two patients, made bilateral neck exploration unnecessary in two patients who had previously undergone parathyroidectomy, and predicted persistent hypercalcemia in two patients with complications.
凭借20年超过700例甲状旁腺切除术的经验，我们术后持续性高钙血症的失败率一直保持在7%。失败原因包括误诊或外科医生无法检测并切除所有分泌过多的腺体。我们对一种市售的完整甲状旁腺激素（PTH）免疫放射分析方法进行了改进，使其周转时间缩短至15分钟。由于完整PTH的半衰期以分钟计，在腺体切除10分钟后采集的全血样本在术中进行监测，以确认循环激素的显著变化。在21例患者中的19例获得了定量证据，证明手术期间所有功能亢进的甲状旁腺组织均已被切除。这些患者中有53%被发现甲状旁腺少于4个。PTH“快速”检测正确地指出了2例患者切除不充分需要进一步进行甲状旁腺切除，使2例先前接受过甲状旁腺切除术的患者无需进行双侧颈部探查，并预测了2例有并发症患者的持续性高钙血症。
