Department of Surgery, William Beaumont Hospital, Royal Oak, MI, USA.
Am J Surg. 2012 Feb;203(2):177-81. doi: 10.1016/j.amjsurg.2010.10.015. Epub 2011 Jul 14.
The aim of this study was to determine whether minimally invasive radioguided parathyroidectomy (MIRP) and intraoperative parathyroid hormone-guided parathyroidectomy (ioPTH) have equivalent intermediate-term outcomes in primary hyperparathyroidism (PHPT).
A retrospective study of 244 patients who underwent parathyroidectomy for PHPT in a 25-month time period was conducted. Patients who either underwent MIRP- or ioPTH-guided parathyroidectomies were included. The primary outcome was persistent disease. Conversion to bilateral exploration, complications, and multigland disease (MGD) were secondary outcomes.
There was 1 MIRP patient and no ioPTH patients who had persistent disease. The ioPTH group had more conversions to a bilateral exploration (bilateral neck exploration [BNE]) (3.7% vs 13%, P = .024). In the MIRP group, no patients were found to have MGD. In the ioPTH group, 7 patients with double adenomas and 6 patients with MGD were found (0 vs 13, P = .0028).
ioPTH facilitates successful minimally invasive parathyroidectomy (MIP) when compared with MIRP and provides cure rates similar to BNE.
本研究旨在确定微创放射性导向甲状旁腺切除术（MIRP）和术中甲状旁腺激素导向甲状旁腺切除术（ioPTH）在原发性甲状旁腺功能亢进症（PHPT）中的中期结果是否相当。
对 25 个月内接受甲状旁腺切除术治疗 PHPT 的 244 例患者进行了回顾性研究。纳入接受 MIRP 或 ioPTH 引导甲状旁腺切除术的患者。主要结果是持续性疾病。次要结果是转为双侧探查、并发症和多腺体疾病（MGD）。
MIRP 组有 1 例患者和无 ioPTH 患者存在持续性疾病。ioPTH 组有更多的患者转为双侧颈探查（BNE）（3.7%比 13%，P=0.024）。在 MIRP 组中，没有发现 MGD 患者。在 ioPTH 组中，发现 7 例双腺瘤和 6 例 MGD 患者（0 比 13，P=0.0028）。
与 MIRP 相比，ioPTH 有利于成功的微创甲状旁腺切除术（MIP），并提供与 BNE 相似的治愈率。
