Ortega Joaquin, Ferrer-Rebolleda Jose, Cassinello Norberto, Lledo Salvador
Department of Surgery, University of Valencia, Clinic University Hospital, Av. Blasco Ibanez 17, 46010 Valencia, Spain.
Eur J Nucl Med Mol Imaging. 2007 Feb;34(2):165-9. doi: 10.1007/s00259-006-0239-7. Epub 2006 Oct 11.
Sestamibi scans have increased the use of minimally invasive parathyroidectomy (MIP) to treat primary hyperparathyroidism (PHPT) when caused by a parathyroid single adenoma. The greatest concern for surgeons remains the proper identification of pathological glands in a limited surgical field. We have studied the usefulness of a new hand-held miniature gamma camera (MGC) when used intraoperatively to locate parathyroid adenomas. To our knowledge this is the first report published on this subject in the scientific literature.
Five patients with PHPT secondary to a single adenoma, positively diagnosed by preoperative sestamibi scans, underwent a MIP. A gamma probe for radioguided surgery and the new hand-held MGC were used consecutively to locate the pathological glands. This new MGC has a module composed of a high-resolution interchangeable collimator and a CsI(Na) scintillating crystal. It has dimensions of around 15 cmx8 cmx9 cm and weighs 1 kg. The intraoperative assay of PTH (ioPTH) was used to confirm the complete resection of pathological tissue.
All cases were operated on successfully by a MIP. The ioPTH confirmed the excision of all pathological tissues. The MGC proved its usefulness in all patients, even in a difficult case in which the first attempt with the gamma probe failed. In all cases it offered real-time accurate intraoperative images.
The hand-held MGC is a useful instrument in MIP for PHPT. It may be used to complement the standard tools used to date, or may even replace them, at least in selected cases of single adenomas.
对于由甲状旁腺单腺瘤引起的原发性甲状旁腺功能亢进症（PHPT），锝[99mTc]甲氧基异丁基异腈（MIBI）扫描增加了微创甲状旁腺切除术（MIP）的应用。外科医生最担心的仍然是在有限的手术视野中正确识别病变腺体。我们研究了一种新型手持式微型γ相机（MGC）在术中用于定位甲状旁腺腺瘤的效用。据我们所知，这是科学文献中关于该主题发表的首篇报告。
5例因单腺瘤导致PHPT的患者，术前经MIBI扫描确诊，接受了MIP。连续使用放射性导向手术用γ探头和新型手持式MGC来定位病变腺体。这种新型MGC有一个由高分辨率可互换准直器和碘化铯（钠）闪烁晶体组成的模块。其尺寸约为15 cm×8 cm×9 cm，重1 kg。术中甲状旁腺激素（ioPTH）测定用于确认病变组织的完全切除。
所有病例均成功进行了MIP手术。ioPTH证实所有病变组织均被切除。MGC在所有患者中都证明了其效用，即使在一例使用γ探头首次尝试失败的困难病例中也是如此。在所有病例中，它都提供了实时准确的术中图像。
手持式MGC在PHPT的MIP中是一种有用的器械。它可用于补充迄今使用的标准工具，或者至少在某些单腺瘤病例中甚至可以替代它们。
