von Breitenbuch P, Iesalnieks I, Piso P, Schlitt H-J, Agha A
Klinik und Poliklinik für Chirurgie, Universitätsklinik Regensburg.
Zentralbl Chir. 2007 Dec;132(6):497-503. doi: 10.1055/s-2007-981374.
The primary hyperparathyroidism (pHPT) is one of the most frequent metabolic diseases. Due to improvement in diagnostics it is a point of interest whether patients with pHPT still suffer from the typical symptoms. Moreover, the question of the best localisation-diagnostics and the most frequent localisation of the adenoma is not yet clarified. New operation strategies and more cost-efficient strategies for diagnostic and therapy could be developed due to the clinically established electrochemiluminescence immunoassay for intraoperative monitoring of intact parathyroid hormone (iPTH).
121 patients with pHPT were operated and retrospectively evaluated between November 1998 and September 2004. Apart from blood parameters, clinical symptoms were examined. As preoperative localisation techniques the ultrasound, the Tc-SestaMIBI scintigraphy, the CT scan and the MRI were used. The monitoring of the iPTH was performed with a special PTH-assay. The histological slices were estimated by a skilful pathologist.
All patients showed an increased PTH level (> 65 ng / l). Nearly 50 % of the patients suffer from more than one symptom. Gastrointestinal- and neuromuscular symptoms were the most frequent symptoms. The best preoperative diagnostic procedure for localisation of the adenoma of the parathyroid gland, in non preoperated patients, seemed to be the combination of ultrasound and scintigraphy. The most common localisation of the adenoma was caudal, on the left side. Intraoperatively, we recognized in 28 from 34 patients an iPTH decrease of more than 50 % of the base value so that the operation could be finished as minimal invasive unilateral cervical exploration.
Patients suffering from pHPT should be treated in a centre with all diagnostic possibilities and surgical experience. Today, the combination of iPTH-monitoring and minimal invasive unilateral cervical exploration should be considered as standard in the surgery of the adrenal gland. Due to our data we recommend an exploration of the left caudal parathyroid gland first if the localisation of the adenoma could not be clarified preoperatively.
原发性甲状旁腺功能亢进症（pHPT）是最常见的代谢性疾病之一。由于诊断技术的进步，pHPT患者是否仍有典型症状成为一个关注焦点。此外，最佳定位诊断方法以及腺瘤最常见的位置问题尚未明确。鉴于临床上已确立的用于术中监测完整甲状旁腺激素（iPTH）的电化学发光免疫测定法，可开发新的手术策略以及更具成本效益的诊断和治疗策略。
1998年11月至2004年9月期间，对121例pHPT患者进行了手术并进行回顾性评估。除血液参数外，还检查了临床症状。术前定位技术采用超声、锝-甲氧基异丁基异腈（Tc-SestaMIBI）闪烁扫描、CT扫描和MRI。使用特殊的PTH测定法监测iPTH。组织学切片由经验丰富的病理学家评估。
所有患者的PTH水平均升高（>65 ng / l）。近50%的患者有不止一种症状。胃肠道和神经肌肉症状是最常见的症状。对于未接受过手术的患者，术前定位甲状旁腺腺瘤的最佳诊断方法似乎是超声和闪烁扫描相结合。腺瘤最常见的位置是左侧尾部。术中，34例患者中有28例iPTH下降超过基础值的50%，因此手术可以作为微创单侧颈部探查完成。
患有pHPT的患者应在具备所有诊断可能性和手术经验的中心接受治疗。如今，iPTH监测与微创单侧颈部探查相结合应被视为肾上腺手术的标准方法。根据我们的数据，如果术前无法明确腺瘤的位置，则建议首先探查左侧尾部甲状旁腺。
