Rubello Domenico, Gross Milton D, Mariani Giuliano, AL-Nahhas Adil
Service of Nuclear Medicine, S. Maria della Misericordia Hospital, Viale Tre Martiti, 140, 45100, Rovigo, and Regional Center of Nuclear Medicine, University of Pisa, Italy.
Eur J Nucl Med Mol Imaging. 2007 Jun;34(6):926-33. doi: 10.1007/s00259-007-0388-3. Epub 2007 Mar 10.
Primary hyperparathyroidism (PHPT) is an increasingly diagnosed disease worldwide. In most cases, PHPT is related to the presence of a solitary parathyroid adenoma (PA). Fifty percent or more of newly diagnosed PHPT patients are asymptomatic, and there is debate among endocrinologists and endocrine surgeons about whether or not such patients should be treated.
Usually, in a PHPT patient with a solitary PA that is well localised pre-operatively, a parathyroidectomy with limited or minimally invasive neck exploration is offered. The diffusion of minimally invasive neck exploration procedures is a consequence of the significant improvement in the accuracy of pre-operative imaging (mainly scintigraphic) techniques; these techniques have changed the surgical strategy to PHPT, from the wide traditional bilateral neck exploration to limited neck exploration.
The present review considers developments during the past 10-15 years with regard to both the accuracy of pre-operative localising imaging techniques and intra-operative minimally invasive procedures in order to provide endocrinologists and endocrine surgeons with further information about the newly available diagnostic and therapeutic tools for use in PHPT patients with a solitary PA.
原发性甲状旁腺功能亢进症（PHPT）在全球范围内的诊断率日益提高。在大多数情况下，PHPT与孤立性甲状旁腺腺瘤（PA）的存在有关。新诊断的PHPT患者中有50%或更多是无症状的，内分泌学家和内分泌外科医生对于此类患者是否应接受治疗存在争议。
通常，对于术前定位良好的孤立性PA的PHPT患者，会进行有限或微创颈部探查的甲状旁腺切除术。微创颈部探查手术的普及是术前成像（主要是闪烁扫描）技术准确性显著提高的结果；这些技术改变了PHPT的手术策略，从传统的广泛双侧颈部探查变为有限颈部探查。
本综述探讨了过去10至15年中术前定位成像技术的准确性和术中微创程序方面的进展，以便为内分泌学家和内分泌外科医生提供有关用于孤立性PA的PHPT患者的新诊断和治疗工具的更多信息。
