Agha Ayman, Scherer Marcus Nils, Mantouvalou Kiriaki, Woenckhaus Matthias, Froehlich Dieter, Barlage Stefan, Dada Ashraf, Schlitt Hans Jürgen
Department of Surgery, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany.
Langenbecks Arch Surg. 2007 Nov;392(6):703-8. doi: 10.1007/s00423-007-0196-z. Epub 2007 May 26.
Intraoperative parathyroid hormone measurement (iPTH) has strengthened the successful use of minimal-invasive approaches in surgery of primary hyperparathyroidism (pHPT). The aim of the study was to evaluate the efficacy of iPTH monitoring in treating pHPT resulting from multiple gland disease.
In this retrospective study, 58 patients with pHPT underwent surgery (minimally invasive or open exploration) between January 2003 and July 2005. iPTH levels were routinely measured at the start of anesthesia, in any case before skin incision, and 10 as well as 15 min after removal of abnormal gland(s). A drop in iPTH >50% after 10 min and >60% after 15 min was considered adequate to prove the success of the removal of the abnormal gland(s). The removed tissue was examined histologically by immediate frozen section.
A single gland disease was found in 51 (88%) cases, a multiple gland disease (double adenoma or hyperplasia) in 7 (12%) cases. In all cases of single adenoma, an adequate drop of iPTH was seen after removal of the pathologic gland. In contrast, in all cases with a second adenoma, an adequate drop in iPTH was detected only after removal of both adenoma/hyperplasia. Immediate sectioning was only helpful for identification of removed tissue, but was no help in deciding whether to search for an additional gland. The follow-up showed no late disease recurrence.
The measurement of iPTH is an effective and safe means in treating single gland disease as well as multiple gland disease (adenoma/hyperplasia) causing pHPT and also allows a successful limited dissection via minimally invasive parathyroidectomy.
术中甲状旁腺激素测定（iPTH）增强了微创方法在原发性甲状旁腺功能亢进症（pHPT）手术中的成功应用。本研究的目的是评估iPTH监测在治疗多腺体疾病所致pHPT中的疗效。
在这项回顾性研究中，58例pHPT患者于2003年1月至2005年7月接受了手术（微创或开放性探查）。iPTH水平在麻醉开始时、无论如何在皮肤切开前、以及切除异常腺体后10分钟和15分钟时常规测量。iPTH在10分钟后下降>50%且在15分钟后下降>60%被认为足以证明异常腺体切除成功。切除的组织通过即时冰冻切片进行组织学检查。
51例（88%）为单腺体疾病，7例（12%）为多腺体疾病（双腺瘤或增生）。在所有单腺瘤病例中，切除病理性腺体后可见iPTH充分下降。相比之下，在所有存在第二个腺瘤的病例中，仅在切除两个腺瘤/增生组织后才检测到iPTH充分下降。即时切片仅有助于识别切除的组织，但无助于决定是否寻找额外的腺体。随访显示无晚期疾病复发。
iPTH测定是治疗引起pHPT的单腺体疾病以及多腺体疾病（腺瘤/增生）的一种有效且安全的方法，并且还能通过微创甲状旁腺切除术成功进行有限的解剖。
