Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana 71130-3932, USA.
Otolaryngol Head Neck Surg. 2011 May;144(5):691-7. doi: 10.1177/0194599811398597.
The aims were to: (1) evaluate whether failure of intraoperative parathyroid hormone (ioPTH) to decrease by the Miami criterion is a more specific indicator of multiglandular disease (MGD) than sestamibi scan and (2) determine an adequate cutoff value for decrease in ioPTH in MGD.
Case series with chart review.
Louisiana State University Health Sciences Center- Shreveport.
Review of subjects undergoing parathyroidectomy using ioPTH and sestamibi for suspected parathyroid adenoma between 2005 and 2009. Patients with MGD were identified by pathology and operative reports.
Eighty-three subjects were identified (68 single adenomas, 11 double adenomas, and 4 multiple-gland hyperplasias). Sestamibi predicted MGD in only 4 of 15 cases (27%). Five of the 11 double adenomas (DAs) were identified during initial surgery; the rest required reoperation for cure. ioPTH was useful in predicting MGD in 7 of 10 cases (70%) when a postexcisional value was drawn after removal of the first enlarged gland. Using the Miami criterion of 50% decrease in ioPTH over 15 minutes would have resulted in 1 unnecessary neck exploration and 3 missed DAs. Requiring both a 50% decrease in ioPTH over 15 minutes and normalization of the postexcisional value would have missed only 1 DA and resulted in a single unnecessary neck exploration.
Sestamibi alone fails to identify MGD 73% of the time, but the success rate increases significantly when combined with ioPTH. The “50% and normal” criterion worked best to increase the success rate in our study population, but larger trials are needed to confirm the utility of this criterion.
本研究旨在：（1）评估与 SPECT 核素扫描相比，术中甲状旁腺激素（ioPTH）下降未达到迈阿密标准是否是多腺体疾病（MGD）的更特异性指标；（2）确定 MGD 中 ioPTH 下降的适当截断值。
病例系列，回顾性图表分析。
路易斯安那州立大学健康科学中心-什里夫波特分校。
对 2005 年至 2009 年间因疑似甲状旁腺腺瘤而行 ioPTH 和 SPECT 核素扫描甲状旁腺切除术的患者进行回顾性分析。通过病理和手术报告确定 MGD 患者。
共纳入 83 例患者（68 例单发腺瘤、11 例双发腺瘤和 4 例多发腺体增生）。SPECT 核素扫描仅能预测 15 例中的 4 例（27%）MGD。11 例双发腺瘤（DA）中有 5 例在初次手术中被发现，其余则需要再次手术以治愈。当在切除第一枚增大的腺体后进行术后 15 分钟的 ioPTH 检测时，ioPTH 对于预测 MGD 是有用的，在 10 例中能预测出 7 例（70%）。如果采用 ioPTH 下降 50%且 15 分钟内恢复正常作为标准，则会导致 1 例不必要的颈部探查和 3 例遗漏的 DA。如果同时要求 ioPTH 下降 50%且术后值正常，则仅会遗漏 1 例 DA，并仅导致 1 例不必要的颈部探查。
SPECT 核素扫描单独应用时，有 73%的时间无法识别 MGD，但与 ioPTH 联合应用时成功率显著提高。在本研究人群中，“下降 50%且正常”的标准可提高成功率，但需要更大规模的试验来证实该标准的实用性。
