采用或不采用术中甲状旁腺激素监测的微创甲状旁腺切除术治疗原发性甲状旁腺功能亢进症。
Minimally invasive parathyroidectomy with or without intraoperative parathyroid hormone for primary hyperparathyroidism.
作者信息
Kim Hyun Gu, Kim Woo Young, Woo Sang Uk, Lee Jae Bok, Lee Yu-Mi
机构信息
Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
出版信息
Ann Surg Treat Res. 2015 Sep;89(3):111-6. doi: 10.4174/astr.2015.89.3.111. Epub 2015 Aug 24.
PURPOSE
The improvement of intraoperative parathyroid hormone (IOPTH) assay and localization studies has enabled a minimally invasive parathyroidectomy (MIP) in primary hyperparathyroidism (pHPT). The aim of this study is to analyze the demographics, clinical presentations, and surgical outcomes of the pHPT patients who received surgical management with versus without IOPTH.
METHODS
Analysis of a database was performed on 53 patients who underwent parathyroidectomy for pHPT from 2004 to 2013. Preoperative localization was done by both sestamibi scan and ultrasonography. We divided the patients into two groups (without IOPTH versus with IOPTH) and analyzed the surgical outcomes statistically between two groups.
RESULTS
The concordance rate of Technetium 99m sestamibi scan and ultrasonography was 73.6% and 90.6%, respectively. The overall cure rate of group 1 (without IOPTH) was 94.9% and that of group 2 (with IOPTH) was 100%. The decline of PTH at postoperative 5 minutes and 10 minutes was 75.2% ± 14.9% and 84.9% ± 8.6% in cured patients. On the other hand, that of noncured patients at 5 minutes and 10 minutes was 17.2% ± 9.7% and 8.2% ± 2.2%. There was a significant difference in the drop rate of IOPTH between cured and persistent patients (P < 0.01). Pathological examination showed adenoma in 41 of 53 patients (77.4%) and hyperplasia in 10 of 53 patients (18.9%).
CONCLUSION
Even though the localization studies were successful, IOPTH monitoring is essential to avoid a surgical failure in MIP.
目的
术中甲状旁腺激素（IOPTH）检测及定位研究的改进，使得原发性甲状旁腺功能亢进症（pHPT）的微创甲状旁腺切除术（MIP）成为可能。本研究旨在分析接受或未接受IOPTH手术治疗的pHPT患者的人口统计学特征、临床表现及手术结果。
方法
对2004年至2013年因pHPT接受甲状旁腺切除术的53例患者的数据库进行分析。术前通过锝99m甲氧基异丁基异腈扫描和超声进行定位。我们将患者分为两组（未使用IOPTH组与使用IOPTH组），并对两组间的手术结果进行统计学分析。
结果
锝99m甲氧基异丁基异腈扫描与超声的符合率分别为73.6%和90.6%。第1组（未使用IOPTH）的总体治愈率为94.9%，第2组（使用IOPTH）为100%。治愈患者术后5分钟和10分钟时甲状旁腺激素（PTH）的下降率分别为75.2%±14.9%和84.9%±8.6%。另一方面，未治愈患者在5分钟和10分钟时的下降率分别为17.2%±9.7%和8.2%±2.2%。治愈患者与持续性患者的IOPTH下降率存在显著差异（P<0.01）。病理检查显示，53例患者中有41例（77.4%）为腺瘤，53例患者中有10例（18.9%）为增生。
结论
尽管定位研究取得成功，但IOPTH监测对于避免MIP手术失败至关重要。
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