术中γ探测器在继发性或三发性甲状旁腺功能亢进手术治疗中的应用
Utility of an intraoperative gamma probe in the surgical management of secondary or tertiary hyperparathyroidism.
作者信息
Jorna Francisca H, Jager Pieter L, Lemstra Clara, Wiggers Theo, Stegeman Coen A, Plukker John T M
机构信息
Department of Surgery/Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
出版信息
Am J Surg. 2008 Jul;196(1):13-8. doi: 10.1016/j.amjsurg.2007.05.059. Epub 2008 Apr 23.
BACKGROUND
In primary hyperparathyroidism the gamma probe is effective, but its role in secondary hyperparathyroidism is unclear. We investigated the utility of the probe in the surgical management of secondary and tertiary hyperparathyroidism.
METHODS
The value of the probe in guiding resection of parathyroids was determined prospectively in 29 patients with secondary or tertiary hyperparathyroidism. Resected tissues with radioactivity of greater than 20% as compared with the wound bed was considered hyperfunctional parathyroid and was confirmed histologically.
RESULTS
The probe was helpful in guiding resection in 13% of the hyperplastic glands, including ectopic glands and those not detected preoperatively. The gamma probe confirmed the presence of hyperfunctional parathyroid after resection with a sensitivity and specificity of 97% and 92%, respectively.
CONCLUSIONS
The probe is particularly useful in confirming the presence of hyperfunctional parathyroids after resection. It also is useful in identifying ectopic localizations, but its value is limited in guiding surgery for secondary or tertiary disease.
背景
在原发性甲状旁腺功能亢进症中，γ探头是有效的，但它在继发性甲状旁腺功能亢进症中的作用尚不清楚。我们研究了该探头在继发性和三发性甲状旁腺功能亢进症手术治疗中的效用。
方法
前瞻性地确定了29例继发性或三发性甲状旁腺功能亢进症患者中探头在指导甲状旁腺切除方面的价值。与伤口床相比，放射性大于20%的切除组织被认为是功能亢进的甲状旁腺，并通过组织学证实。
结果
该探头在13%的增生性腺体（包括异位腺体和术前未检测到的腺体）切除指导中是有帮助的。γ探头在切除后确认功能亢进甲状旁腺的存在，敏感性和特异性分别为97%和92%。
结论
该探头在切除后确认功能亢进甲状旁腺的存在方面特别有用。它在识别异位定位方面也有用，但在指导继发性或三发性疾病的手术方面价值有限。
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