Calò P G, Pisano G, Tatti A, Medas F, Boi F, Mariotti S, Nicolosi A
Dipartimento di Chirurgia e Scienze Odontostomatologiche, Università degli Studi di Cagliari, Cagliari, Italia.
Minerva Chir. 2012 Aug;67(4):337-42.
Intraoperative parathyroid hormone (PTH) assay has become an essential tool in focused parathyroid surgery. The aim of this study was to evaluate the present role of intraoperative PTH monitoring during focused parathyroidectomy for primary hyperparathyroidism in our experience.
One hundred sixty-one patients were submitted to focused parathyroidectomy with rapid intraoperative Parathyroid hormone assay monitoring.
A >50% decrease of PTH occurred in 147 patients (91.3%); in this group persistent hypercalcemia was found in 1; in the remaining 14 (8.7%) values of PTH decreased less than 50% and bilateral neck exploration was performed. An additional pathologic parathyroid was removed in 8 cases, a third in one; in the other five further neck exploration was negative and in four of these persistent postoperative hypercalcemia was demonstrated. In 136 patients >50% decrease of PTH was obtained after 10 minutes, in the other 11 after 20. The overall operative success of the patients was 96.9% with a 5.6% incidence of multiglandular disease. Intraoperative parathormone monitoring changed the operative management in 8.7% of cases. Intraoperative parathormone monitoring was accurate in predicting operative success or failure in 98.7% of patients, with a sensitivity of 99.3%, a specificity of 92.8%, a positive predictive value of 99.3% and a negative predictive value of 92.8%.
The measurement of intraoperative PTH represents a useful tool to assist the surgeon during parathyroid surgery and its routine use significantly improves cure rates of focused parathyroidectomy. We believe that the use intraoperative PTH is still mandatory in focused parathyroidectomy avoiding relapses and consequent reintervention.
术中甲状旁腺激素（PTH）检测已成为甲状旁腺聚焦手术的重要工具。本研究旨在根据我们的经验评估术中PTH监测在原发性甲状旁腺功能亢进症甲状旁腺聚焦切除术中的当前作用。
161例患者接受了甲状旁腺聚焦切除术，并进行了术中快速甲状旁腺激素检测监测。
147例患者（91.3%）的PTH下降>50%；该组中1例发现持续性高钙血症；其余14例（8.7%）PTH值下降小于50%，遂进行双侧颈部探查。8例切除了额外的病理性甲状旁腺，1例切除了第三个；另外5例进一步颈部探查为阴性，其中4例术后出现持续性高钙血症。136例患者在10分钟后PTH下降>50%，另外11例在20分钟后下降。患者的总体手术成功率为96.9%，多腺体疾病发生率为5.6%。术中甲状旁腺激素监测在8.7%的病例中改变了手术管理方式。术中甲状旁腺激素监测在98.7%的患者中准确预测了手术成功或失败，敏感性为99.3%，特异性为92.8%，阳性预测值为99.3%，阴性预测值为92.8%。
术中PTH检测是甲状旁腺手术中协助外科医生的有用工具，其常规使用显著提高了甲状旁腺聚焦切除术的治愈率。我们认为，在甲状旁腺聚焦切除术中使用术中PTH对于避免复发和后续再次干预仍然是必不可少的。
