Chen Herbert, Sippel Rebecca S, Schaefer Sarah
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin Medical School, H4/750 Clinical Science Center, Madison, WI 53792, USA.
Arch Surg. 2009 Jul;144(7):643-8. doi: 10.1001/archsurg.2009.104.
Many surgeons have shown that radio-guided resection of parathyroid glands can facilitate intraoperative localization in selected patients with primary hyperparathyroidism, especially in the reoperative setting. However, in patients with negative technetium Tc 99m-sestamibi (hereafter referred to as "sestamibi") scans, the usefulness of the gamma probe is unclear. Thus, we were interested in determining the role of radio-guided techniques in patients with primary hyperparathyroidism and negative or nonlocalizing sestamibi scans.
Retrospective analysis of a prospective parathyroid database.
Academic medical center.
Seven hundred sixty-nine patients with primary hyperparathyroidism who had a sestamibi scan and underwent surgical invention by a single surgeon. All patients had radioguided parathyroidectomy using a handheld gamma probe.
Radioactive counts, eucalcemia rate, and complications were compared between patients with positive and patients with negative sestamibi scans.
All enlarged parathyroid glands were localized with the gamma probe in patients with a negative or with a positive sestamibi scan with similar sensitivities. This occurred despite the fact that smaller parathryoid glands were present, on average, in patients with negative sestamibi scans (428 mg vs 828 mg, P = .001). Equivalent high postoperative eucalcemia rates (>98%) and low complication rates (0.5%) were achieved with radioguided techniques in both patient populations.
Radioguided techniques are equally effective in patients with negative (nonlocalizing) sestamibi scans undergoing parathyroidectomy for primary hyperparathyroidism. Moreover, use of the gamma probe led to the detection of all parathyroid glands, including ectopically located ones. These data suggest that the gamma probe has an important role for localization of parathyroid glands in patients with negative preoperative sestamibi scans.
许多外科医生已表明，放射性引导下甲状旁腺切除术可促进原发性甲状旁腺功能亢进症特定患者的术中定位，尤其是在再次手术的情况下。然而，对于锝 Tc 99m - 甲氧基异丁基异腈（以下简称“甲氧基异丁基异腈”）扫描结果为阴性的患者，γ 探头的实用性尚不清楚。因此，我们感兴趣的是确定放射性引导技术在原发性甲状旁腺功能亢进症且甲氧基异丁基异腈扫描结果为阴性或无定位的患者中的作用。
对前瞻性甲状旁腺数据库进行回顾性分析。
学术医疗中心。
769 例原发性甲状旁腺功能亢进症患者，他们接受了甲氧基异丁基异腈扫描，并由同一位外科医生进行手术干预。所有患者均使用手持式 γ 探头进行放射性引导甲状旁腺切除术。
比较甲氧基异丁基异腈扫描结果为阳性和阴性的患者之间的放射性计数、血钙正常率和并发症情况。
在甲氧基异丁基异腈扫描结果为阴性或阳性的患者中，所有增大的甲状旁腺均通过 γ 探头定位，敏感性相似。尽管甲氧基异丁基异腈扫描结果为阴性的患者平均甲状旁腺较小（428 毫克对 828 毫克，P = 0.001），但仍出现这种情况。在这两组患者中，放射性引导技术均实现了相当高的术后血钙正常率（>98%）和低并发症率（0.5%）。
放射性引导技术在原发性甲状旁腺功能亢进症患者中，对于甲氧基异丁基异腈扫描结果为阴性（无定位）的患者进行甲状旁腺切除术同样有效。此外，使用 γ 探头可检测到所有甲状旁腺，包括异位甲状旁腺。这些数据表明，γ 探头在术前甲氧基异丁基异腈扫描结果为阴性的患者甲状旁腺定位中具有重要作用。
