Takeyama Hiroshi, Shioya Hisashi, Ogi Shigeyuki, Yokoyama Keitaro, Yamamoto Hiroyasu, Odaka Makoto, Sato Shuji, Kinoshita Satoki, Uchida Ken, Morikawa Toshiaki
Department of Surgery, The Jikei University School of Medicine, Nishi-sinbashi, Tokyo, Japan.
Int Surg. 2009 Apr-Jun;94(2):154-63.
99mTc-MIBI-guided detection of abnormal parathyroid glands in primary hyperparathyroidism (1-HPT) has become a popular and effective technique, but its efficacy for detecting the ectopic glands of secondary hyperparathyroidism (2-HPT) is still controversial. Of the 2-HPT cases from 2000 to 2004, 14 ectopic parathyroid glands in 11 patients were resected using intraoperative 99mTc-MIBI scintigraphy. We evaluated and compared the results of radioguided surgery with the preoperative findings from ultrasonography (US), computed tomography (CT), and scintigraphy. The overall results for intraoperative 99mTc-MIBI-guided detection of ectopic parathyroid glands were sensitivity of 100% (14/14) and accuracy of 84.2% (16/19) compared with 42.9% (6/14) and 31.6% (6/19), respectively, for preoperative US and 50.0% (6/12) and 42.9% (6/14), respectively, for preoperative 99mTc-MIBI scintigraphy. Using intraoperative 99mTc-MIBI-guided surgery in cases of 2-HPT will ensure all ectopic parathyroid glands are detected, making the surgery easier to perform and the outcome more successful.
99mTc-MIBI引导下检测原发性甲状旁腺功能亢进症（1-HPT）中异常甲状旁腺已成为一种流行且有效的技术，但其检测继发性甲状旁腺功能亢进症（2-HPT）异位甲状旁腺的功效仍存在争议。在2000年至2004年的2-HPT病例中，对11例患者的14个异位甲状旁腺进行了术中99mTc-MIBI闪烁扫描切除。我们评估并比较了放射性引导手术的结果与术前超声（US）、计算机断层扫描（CT）和闪烁扫描的结果。术中99mTc-MIBI引导检测异位甲状旁腺的总体结果为敏感性100%（14/14）、准确性84.2%（16/19），相比之下，术前US的敏感性和准确性分别为42.9%（6/14）和31.6%（6/19），术前99mTc-MIBI闪烁扫描的敏感性和准确性分别为50.0%（6/12）和42.9%（6/14）。在2-HPT病例中使用术中99mTc-MIBI引导手术将确保检测到所有异位甲状旁腺，使手术更易于实施且结果更成功。
