Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
Ann Nucl Med. 2010 May;24(4):233-40. doi: 10.1007/s12149-010-0366-x. Epub 2010 Mar 25.
Clinical or subclinical hyperparathyroidism (HPT) is one of the most common endocrine disorders. In patients with HPT who meet the indications for parathyroidectomy, complete surgical resection of all hyperfunctioning parathyroid tissue is essential for the curative treatment. The conventional surgical approach is bilateral neck exploration, whereas minimally invasive parathyroidectomy has been made possible by the introduction of (99m)Tc-sestamibi scintigraphy for preoperative localization of parathyroid adenomas. In minimally invasive surgery, the surgeon expects some modalities that predict complete resection of all hyperfunctioning parathyroid glands. The prevalence rate of (99m)Tc-sestamibi scanning for single parathyroid adenoma was widely accepted as 85-95%. Moreover, the recent developing technology of semiconductor electronics has produced useful portable gamma-probes. Intraoperative navigation using these devices provides the possibility of easy and definitive identification of parathyroid nodules during the operation. In minimally invasive radioguided parathyroidectomy using gamma-probe, different protocols are based on different timing and doses of tracer injected. Each procedure is technically easy, safe, with a low morbidity rate, and has better cosmetic results and lower overall cost than conventional bilateral neck exploration. We have applied this technique in selected patients and achieved success comparable to that achieved with contemporaneously performed standard neck exploration. In the hands of a competent surgeon, the use of sestamibi scanning and radioguided parathyroidectomy in appropriately selected patients is a useful technique.
临床或亚临床甲状旁腺功能亢进症（HPT）是最常见的内分泌疾病之一。对于符合甲状旁腺切除术适应证的 HPT 患者，彻底切除所有功能亢进的甲状旁腺组织是治愈该病的关键。传统的手术方法是双侧颈部探查，而核素（99m）Tc-甲氧基异丁基异腈（sestamibi）扫描术前定位甲状旁腺瘤的引入使得微创甲状旁腺切除术成为可能。在微创手术中，外科医生期望有一些方法可以预测所有功能亢进的甲状旁腺的完全切除。核素（99m）Tc-甲氧基异丁基异腈扫描单个甲状旁腺瘤的阳性率被广泛接受为 85%-95%。此外，半导体电子技术的最新发展产生了有用的便携式γ探头。术中使用这些设备进行导航为手术期间容易且明确地识别甲状旁腺结节提供了可能。在使用γ探头的微创放射性导向甲状旁腺切除术，不同的方案基于不同的示踪剂注射时间和剂量。每个程序在技术上都很简单、安全、发病率低，并且与同期进行的传统双侧颈部探查相比，具有更好的美容效果和更低的总体成本。我们已经在选定的患者中应用了这项技术，并取得了与同期进行的标准颈部探查相当的成功。在熟练的外科医生手中，对于适当选择的患者，使用 sestamibi 扫描和放射性导向甲状旁腺切除术是一种有用的技术。
