Seybt Melanie W, Loftus Kelly A, Mulloy Anthony L, Terris David J
Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, Georgia 30912-4060, USA.
Laryngoscope. 2009 Jul;119(7):1331-3. doi: 10.1002/lary.20500.
OBJECTIVES/HYPOTHESIS: Localization and the intraoperative parathyroid hormone assay (IOPTH) have facilitated minimally invasive parathyroidectomy. The precise algorithm governing use of IOPTH has been debated. Numerous authors advocate acquisition of a so-called pre-excision (P-E) baseline level (obtained after dissection of the adenoma, but prior to excision) in addition to a preincision baseline, to guard against spurious elevation in the baseline that might confuse interpretation of postexcision levels. We sought to clarify the optimal timing of PTH level determination.
Consecutive single-surgeon case series with planned data collection from patients undergoing parathyroid surgery at a university hospital.
Demographic data and intraoperative laboratory and surgical findings from patients undergoing parathyroidectomy were prospectively gathered and analyzed. Attention was paid to the value of P-E and 5-minute postexcision levels and their impact on intraoperative decision-making.
One hundred twelve patients underwent parathyroidectomy. Thirty were for secondary or tertiary hyperparathyroidism and were excluded. Seventy-nine (96.3%) of the 82 patients with primary hyperparathyroidism were rendered eucalcemic. In no case did the P-E value change what was otherwise destined to be a successful result. In 65.3% of cases, operative time was conserved as the procedure was correctly stopped after the 5-minute level, without the need to wait until the 10-minute postexcision level was reported.
Pre-excision baseline IOPTH levels, although logical in their original proposal, appear to play little role in determining the completeness of an exploration. A 5-minute postexcision level adds value in nearly two thirds of cases by allowing earlier termination of the operation.
目的/假设：定位技术和术中甲状旁腺激素测定（IOPTH）推动了微创甲状旁腺切除术的发展。关于IOPTH使用的精确算法一直存在争议。许多作者主张除了术前基线水平外，还应获取所谓的切除前（P-E）基线水平（在腺瘤解剖后但切除前获得），以防止基线出现假性升高，以免混淆对切除后水平的解读。我们试图阐明PTH水平测定的最佳时机。
对在大学医院接受甲状旁腺手术的患者进行连续单术者病例系列研究，并计划收集数据。
前瞻性收集并分析接受甲状旁腺切除术患者的人口统计学数据、术中实验室检查结果和手术发现。重点关注P-E水平和切除后5分钟水平的价值及其对术中决策的影响。
112例患者接受了甲状旁腺切除术。其中30例因继发性或三发性甲状旁腺功能亢进被排除。82例原发性甲状旁腺功能亢进患者中有79例（96.3%）血钙恢复正常。在任何情况下，P-E值都没有改变原本注定会成功的结果。在65.3%的病例中，由于在5分钟水平后手术被正确终止，节省了手术时间，无需等到报告切除后第10分钟的水平。
切除前基线IOPTH水平，尽管最初提出时有其合理性，但在确定探查的完整性方面似乎作用不大。切除后5分钟的水平在近三分之二的病例中具有价值，因为它可以使手术更早结束。
