快速术中甲状旁腺激素测定在甲状旁腺功能亢进手术治疗中的应用
Rapid intraoperative parathyroid hormone assay in the surgical management of hyperparathyroidism.
作者信息
Nelson Craig M, Victor Noel S
出版信息
Perm J. 2007 Winter;11(1):3-6. doi: 10.7812/TPP/04-082.
CONTEXT
Historically, successful surgical management of primary hyperparathyroidism has required bilateral exploration of the neck. By confirming complete removal of hypersecreting tissue, an intraoperative parathyroid hormone (IO-PTH) assay allows use of a more limited procedure.
OBJECTIVE
Our objective was to evaluate the utility of IO-PTH assay used in 32 parathyroid explorations versus conventional bilateral exploration used before the advent of IO-PTH assays.
METHODS
Minimally invasive parathyroidectomy (MIP) was used. Plasma samples were obtained at several intervals and were analyzed for IO-PTH by use of a rapid immunochemiluminescent assay (ICMA). Outcomes were assessed by univariate inferential testing, yielding one-tailed t-test results.
RESULTS
The study group had a mean plasma IO-PTH level decrease of 87% at ten minutes after excision. All 32 patients who underwent MIP using IO-PTH monitoring had successful surgery. At last postoperative follow-up examination, all 32 patients were normocalcemic. There were statistically significant decreases in duration of surgery, length of hospital stay, and surgery cost.
CONCLUSIONS
IO-PTH levels predicted the postoperative outcome for all patients studied, can provide valuable information to surgeons, and can decrease the duration of surgery and hospital stay.
背景
从历史上看，原发性甲状旁腺功能亢进症的成功手术治疗需要双侧颈部探查。通过确认完全切除分泌过多的组织，术中甲状旁腺激素（IO-PTH）检测允许采用更有限的手术方式。
目的
我们的目的是评估在32例甲状旁腺探查中使用IO-PTH检测与在IO-PTH检测出现之前使用的传统双侧探查相比的效用。
方法
采用微创甲状旁腺切除术（MIP）。在几个时间点采集血浆样本，并使用快速免疫化学发光分析法（ICMA）分析IO-PTH。通过单变量推断测试评估结果，得出单尾t检验结果。
结果
研究组在切除后十分钟时血浆IO-PTH水平平均下降87%。所有32例使用IO-PTH监测进行MIP的患者手术均成功。在术后最后一次随访检查时，所有32例患者血钙水平均正常。手术时间、住院时间和手术费用均有统计学意义的下降。
结论
IO-PTH水平预测了所有研究患者的术后结果，可为外科医生提供有价值的信息，并可缩短手术时间和住院时间。
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