慢性肾衰竭所致继发性甲状旁腺功能亢进患者的放射性引导甲状旁腺切除术

Radioguided parathyroidectomy in patients with secondary hyperparathyroidism due to chronic renal failure.

作者信息

Chen Jun, Wang Jia-dong

机构信息

Department of Otolaryngology Head and Neck Surgery, Shanghai RenJi hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China.

出版信息

Nucl Med Commun. 2014 Apr;35(4):391-7. doi: 10.1097/MNM.0000000000000062.

DOI:10.1097/MNM.0000000000000062

PMID:24335878

Abstract

OBJECTIVE

The aim of the study was to determine the effectiveness of radioguided parathyroidectomy in patients with secondary hyperparathyroidism (sHPT) due to chronic renal failure (CRF).

METHODS

Between August 2003 and October 2011, CRF patients undergoing parathyroidectomy for sHPT received conventional parathyroidectomy with preoperative ultrasound localization or radioguided surgery. For radioguided surgery, 370 MBq of (99m)Tc-sestamibi was injected intravenously 1.5-2 h before surgery, and a gamma probe was used intraoperatively to identify the parathyroid glands by radioactivity count.

RESULTS

Twenty-five patients underwent conventional parathyroidectomy and 25 underwent radioguided parathyroidectomy. The median patient age was 55 years (range, 37-75 years). In the conventional surgery group, the parathyroid glands were removed in 18 patients, and seven patients experienced recurrence as determined by intact parathyroid hormone (iPTH) levels. One patient in the radioguided surgery group experienced recurrence due to ectopic parathyroid tissue in the mediastinum. The operative time of radioguided surgery was shorter than that of conventional surgery [median (interquartile range), 100.0 (84.0-118.0) vs. 114.0 (103.0-134.0) min, respectively; P=0.015]. On postoperative day 1, iPTH and serum calcium levels were significantly lower in the radioguided surgery group than in the conventional surgery group [median (interquartile range), iPTH: 3 (3-20) vs. 53 (11-230) ng/l; P=0.006, calcium: 1.72 (1.63-1.85) vs. 2.06 (1.92-2.12) mmol/l; P<0.001]. Radioactivity counts of parathyroid glands were significantly higher than in thyroid tissue, lymph nodes, and fat (all, P<0.001).

CONCLUSION

Radioguided localization of the parathyroid glands improves the success rate of surgery in patients with CRF undergoing parathyroidectomy for sHPT.

摘要

目的

本研究旨在确定放射性引导甲状旁腺切除术对慢性肾衰竭（CRF）所致继发性甲状旁腺功能亢进（sHPT）患者的有效性。

方法

2003年8月至2011年10月期间，因sHPT接受甲状旁腺切除术的CRF患者接受了术前超声定位的传统甲状旁腺切除术或放射性引导手术。对于放射性引导手术，在手术前1.5 - 2小时静脉注射370 MBq的（99m）Tc - 甲氧基异丁基异腈，术中使用γ探测器通过放射性计数识别甲状旁腺。

结果

25例患者接受了传统甲状旁腺切除术，25例接受了放射性引导甲状旁腺切除术。患者中位年龄为55岁（范围37 - 75岁）。在传统手术组中，18例患者的甲状旁腺被切除，7例患者根据完整甲状旁腺激素（iPTH）水平确定复发。放射性引导手术组中有1例患者因纵隔异位甲状旁腺组织复发。放射性引导手术的手术时间短于传统手术[中位数（四分位间距）分别为100.0（84.0 - 118.0）分钟和114.0（103.0 - 134.0）分钟；P = 0.015]。术后第1天，放射性引导手术组的iPTH和血清钙水平显著低于传统手术组[中位数（四分位间距），iPTH：3（3 - 20）与53（11 - 230）ng/l；P = 0.006，钙：1.72（1.63 - 1.85）与2.06（1.92 - 2.12）mmol/l；P < 0.001]。甲状旁腺的放射性计数显著高于甲状腺组织、淋巴结和脂肪（均P < 0.001）。