Department of General Surgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Thyroid. 2010 Nov;20(11):1271-8. doi: 10.1089/thy.2009.0441. Epub 2010 Oct 18.
The purpose of this study was to investigate the efficiency of a radioguided occult lesion localization technique in reoperative thyroid and parathyroid procedures in patients who had undergone previous neck exploration for thyroid or parathyroid disease.
Twenty-one consecutive patients who were scheduled for reoperative thyroid or parathyroid surgery were studied. The indication for reoperation was recurrent papillary thyroid cancer (PTC) in eight patients, completion thyroidectomy for PTC in eight patients who had previously undergone a bilateral subtotal thyroidectomy, recurrent goiter in two patients, primary hyperparathyroidism in two patients, and recurrent parathyroid cancer in one patient. Ninety minutes before surgery, 0.1 mL of Technetium-99m (0.2 mCi)-labeled macroaggregated albumin was injected directly into the lesion under ultrasonographic guidance. During surgery, a handheld gamma probe was used to localize and excise the lesions. The background and postexcisional site radioactivities were compared to confirm the completeness of each procedure. The radiation dose in the operating room environment, duration of surgery, and postoperative complication rates were evaluated in all patients. In patients with PTC, the change in serum thyroglobulin (Tg) following surgery was noted.
Thirty lesions were marked and excised. The postexcisional bed gamma counts (610 ± 141) were markedly decreased compared with the pre-excisional site counts (21,415.8 ± 4993.4; p = 0.0001). The ratio of the postexcisional and background counts (4.6 ± 4.3) was significantly lower than the ratio of the pre-excisional and background counts (173.7 ± 156.4; p = 0.0001). The mean operation duration was 53.3 ± 7.5 minutes. The dose absorbed by the hands of the surgeon was estimated as 0.07 ± 0.02 and 0.15 ± 0.05 millisievert/h when one or three lesions were marked, respectively. One patient developed postoperative transient hypoparathyroidism. After surgery, serum Tg levels dropped to <2 ng/mL in 86% (6/7) of the patients with PTC whose preoperative serum Tg was elevated.
The radioguided occult lesion localization technique was efficient in the perioperative identification of thyroid and parathyroid tumors in patients who were undergoing reoperation for PTC and hyperparathyroidism.
本研究旨在探讨放射性示踪隐匿性病灶定位技术在因甲状腺或甲状旁腺疾病行颈部探查后的再次甲状腺和甲状旁腺手术中的效率。
研究了 21 例计划行再次甲状腺或甲状旁腺手术的连续患者。再次手术的指征为：8 例复发性甲状腺乳头状癌（PTC），8 例先前行双侧甲状腺次全切除术的 PTC 患者行全甲状腺切除术，2 例复发性甲状腺肿，2 例原发性甲状旁腺功能亢进，1 例复发性甲状旁腺癌。手术前 90 分钟，经超声引导将 0.1 毫升锝-99m（0.2 毫居里）标记的巨聚合白蛋白直接注射到病灶中。手术过程中，使用手持式伽马探针定位并切除病灶。比较背景和切除后部位的放射性以确认每个程序的完整性。评估了所有患者的手术室环境辐射剂量、手术持续时间和术后并发症发生率。在 PTC 患者中，注意术后血清甲状腺球蛋白（Tg）的变化。
标记并切除了 30 个病灶。切除后床的伽马计数（610 ± 141）明显低于术前部位的计数（21415.8 ± 4993.4；p = 0.0001）。切除后与背景的比值（4.6 ± 4.3）明显低于切除前与背景的比值（173.7 ± 156.4；p = 0.0001）。平均手术时间为 53.3 ± 7.5 分钟。当标记一个或三个病灶时，估计术者手部吸收的剂量分别为 0.07 ± 0.02 和 0.15 ± 0.05 毫西弗/小时。1 例患者术后出现短暂性甲状旁腺功能减退。术后，7 例术前血清 Tg 升高的 PTC 患者中，6 例（86%）血清 Tg 降至<2ng/ml。
放射性示踪隐匿性病灶定位技术在因 PTC 和甲状旁腺功能亢进而行再次手术的患者中，对甲状腺和甲状旁腺肿瘤的围手术期识别是有效的。
