Tardin L, Prats E, Andrés A, Razola P, Deus J, Gastaminza R, Santapau A, Parra A, Banzo J
Servicio de Medicina Nuclear, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
Rev Esp Med Nucl. 2011 Jan-Feb;30(1):19-23. doi: 10.1016/j.remn.2010.09.003. Epub 2011 Jan 3.
The aim of this study was to evaluate the role of (99m)Tc-MIBI parathyroid scintigraphy and radioguided parathyroidectomy on the diagnosis and treatment of primary hyperparathyroidism (PHP) due to ectopic adenomas.
We reviewed 105 consecutive patients who underwent radioguided parathyroidectomy due to adenomas between March 2004 and December 2008. Of this group we studied 20 patients (19%) with ectopic adenomas. All patients had biochemical evidence of PHP, a positive parathyroid scintigraphy, radioguided detection with histolopathological confirmation of adenoma and at least 1 year-follow up. The parathyroid scintigraphy consisted on dual-phase planar and tomographic images (SPECT or SPECT/CT). During the parathyroidectomy, intraoperative PTH determinations (0, 7, 15 and 30 min after the parathyroidectomy) were done. The follow up consisted on blood examinations of PTH, calcium, phosphorus and vitamin D and assessment of renal function.
Parathyroid scintigraphy detected all adenomas. Scintigraphic and surgical findings were coincident in 18 cases (90%). The final adenoma localization was paraesophagic in 9 patients, cervicothymic in 5, posterior cervicomediastinal in 4, anterior mediastinal in 1 and parathymic in 1. The parathyroidectomy consisted on 12 minimally invasive surgeries, 2 unilateral cervicotomies, 4 bilateral cervicotomies and 2 sternotomies. No case of persistent or recurrent PHP was observed during the follow up.
Parathyroid scintigraphy (SPECT/CT) and radioguided surgery are effective methods on the localization and treatment of PHP due to ectopic adenomas. In our study the radioguided parathyroidectomy was successful in all cases and there was no evidence of persistent or recurrent hyperparathyroidism on the follow up.
本研究旨在评估（99m）Tc - MIBI甲状旁腺闪烁扫描及放射性引导甲状旁腺切除术在诊断和治疗异位腺瘤所致原发性甲状旁腺功能亢进症（PHP）中的作用。
我们回顾了2004年3月至2008年12月期间因腺瘤接受放射性引导甲状旁腺切除术的105例连续患者。在该组中，我们研究了20例（19%）异位腺瘤患者。所有患者均有PHP的生化证据、甲状旁腺闪烁扫描阳性、放射性引导检测且腺瘤经组织病理学证实，并且至少随访1年。甲状旁腺闪烁扫描包括双期平面及断层图像（SPECT或SPECT/CT）。在甲状旁腺切除术中，进行了术中甲状旁腺激素（PTH）测定（甲状旁腺切除术后0、7、15和30分钟）。随访包括对PTH、钙、磷和维生素D进行血液检查以及评估肾功能。
甲状旁腺闪烁扫描检测到了所有腺瘤。闪烁扫描和手术结果在18例（90%）中一致。最终腺瘤定位为食管旁9例、颈胸腺区5例、颈后纵隔4例、前纵隔1例、胸腺旁1例。甲状旁腺切除术包括12例微创手术、2例单侧颈部切开术、4例双侧颈部切开术和2例胸骨切开术。随访期间未观察到持续性或复发性PHP病例。
甲状旁腺闪烁扫描（SPECT/CT）和放射性引导手术是诊断和治疗异位腺瘤所致PHP的有效方法。在我们的研究中，放射性引导甲状旁腺切除术在所有病例中均成功，且随访中没有持续性或复发性甲状旁腺功能亢进的证据。
