Daliakopoulos Stavros I, Chatzoulis George, Lampridis Savvas, Pantelidou Varvara, Zografos Omiros, Ioannidis Konstantinos, Sapranidis Michael, Ploumis Avraam
Department of Thoracic Surgery, 424 General Military Hospital, Eukarpia Ring Road, Thessaloniki Gr 564 29, Greece.
J Cardiothorac Surg. 2014 Mar 31;9:62. doi: 10.1186/1749-8090-9-62.
Primary hyperparathyroidism due to parathyroid adenomas may be associated with ectopic parathyroid gland localization in 20-25% of the patients. We report herein the excision of an ectopic parathyroid adenoma which was detected in the thymus gland by gamma probe intraoperatively. A 38-year-old patient presented to our clinic with a history of bilateral nephrolithiasis, chronic hypercalcaemia, and PTH elevation. A combination of Technetium-99 m sestamibi scintigraphy and Computed Tomography scan of the chest and neck revealed an ectopic parathyroid adenoma of 8.5 mm in its greatest dimension. The patient underwent sternotomy and the adenoma was found within the right lobe of the thymus gland with the intraoperative use of gamma probe. PTH detection and frozen biopsy were performed during surgery and confirmed the successful excision of the adenoma, while mild hypocalcaemia was noticed postoperatively. We conclude that accurate preoperative and intraoperative localization of an ectopic parathyroid adenoma is crucial to successful surgery. The use of at least two diagnostic modalities before surgical excision minimizes the risk of re-operation for recurrent hyperparathyroidism, while the intraoperative use of gamma probe offers a significant advantage over conventional techniques by reducing surgical time, morbidity and/or complications associated with surgical exploration.
由甲状旁腺腺瘤引起的原发性甲状旁腺功能亢进在20%至25%的患者中可能与异位甲状旁腺定位有关。我们在此报告一例异位甲状旁腺腺瘤的切除病例，该腺瘤在术中通过γ探测仪在胸腺中被检测到。一名38岁患者因双侧肾结石、慢性高钙血症和甲状旁腺激素升高病史前来我院就诊。99m锝甲氧基异丁基异腈闪烁扫描与胸部和颈部计算机断层扫描相结合，发现一个最大直径为8.5毫米的异位甲状旁腺腺瘤。患者接受了胸骨切开术，术中使用γ探测仪在胸腺右叶发现了腺瘤。手术期间进行了甲状旁腺激素检测和冰冻活检，证实腺瘤已成功切除，术后出现轻度低钙血症。我们得出结论，异位甲状旁腺腺瘤的准确术前和术中定位对手术成功至关重要。手术切除前使用至少两种诊断方法可将复发性甲状旁腺功能亢进再次手术的风险降至最低，而术中使用γ探测仪通过减少手术时间、发病率和/或与手术探查相关的并发症，比传统技术具有显著优势。
