Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI 53792-7375, USA.
Ann Surg. 2010 Jun;251(6):1127-30. doi: 10.1097/SLA.0b013e3181d3d264.
This study was designed to determine if a rising intraoperative parathyroid hormone (ioPTH) level following parathyroid resection indicates multiple hyperfunctioning glands and to determine the appropriate intraoperative management.
IoPTH monitoring is commonly used to guide parathyroid surgery. A significant rise in the ioPTH immediately after resection of a single parathyroid is often perceived to be indicative of the presence of additional hyperfunctioning glands.
A total of 797 consecutive patients underwent parathyroidectomy for primary hyperparathyroidism with ioPTH monitoring. Patients with an elevated 5 minute ioPTH were extensively studied. Operative success was defined as normocalcemia 6 months after surgery.
Of the 797 patients, 108 (14%) had a rising ioPTH 5 minutes after resection of a single parathyroid. Of these 108 patients, 36 (33%) continued to have elevated ioPTH levels and further exploration revealed additional hyperfunctioning glands. Importantly, in the majority of patients (n = 72 or 67%), the ioPTH started to fall after an additional 5 minutes (10 minutes after resection). The ioPTH declined by more than 50% from the 5 minute elevated value in 30%, 89%, and 99% of patients at 10, 15, and 20 minutes after resection, respectively. Importantly, this fall correctly predicted operative success in 100% of patients after removal of a single abnormal gland.
A rising ioPTH level immediately after parathyroidectomy is observed in 14% of patients. The majority of these patients do not have additional hyperfunctioning glands. Most of patients fell below 50% of the 5 minute elevated value within 20 minutes of gland resection and in all cases this fall correctly predicted operative success.
本研究旨在确定甲状旁腺切除术后甲状旁腺激素（ioPTH）水平升高是否表明存在多个功能亢进的腺体，并确定适当的术中管理方法。
ioPTH 监测常用于指导甲状旁腺手术。切除单个甲状旁腺后，ioPTH 立即显著升高，通常被认为表明存在其他功能亢进的腺体。
共有 797 例连续原发性甲状旁腺功能亢进患者接受 ioPTH 监测下甲状旁腺切除术。对升高的 5 分钟 ioPTH 患者进行了广泛研究。手术成功定义为术后 6 个月血钙正常。
在 797 例患者中，108 例（14%）在切除单个甲状旁腺后 5 分钟时 ioPTH 升高。在这 108 例患者中，36 例（33%）继续存在升高的 ioPTH 水平，进一步探查发现存在其他功能亢进的腺体。重要的是，在大多数患者（n=72 或 67%）中，ioPTH 在额外 5 分钟后（切除后 10 分钟）开始下降。ioPTH 在切除后 10、15 和 20 分钟时分别从 5 分钟升高值下降超过 50%，在 30%、89%和 99%的患者中下降超过 50%。重要的是，在切除单个异常腺体后，这一下降在 100%的患者中正确预测了手术成功。
甲状旁腺切除术后 14%的患者出现 ioPTH 水平升高。大多数患者不存在其他功能亢进的腺体。大多数患者在切除腺体后 20 分钟内降至 5 分钟升高值的 50%以下，在所有情况下，这一下降都正确预测了手术成功。
