Khan Angela A, Khatun Yasmin, Walker Abigail, Jimeno Jaime, Hubbard Johnathan G
Department Endocrine Surgery, Guys and St Thomas' Hospital NHS Foundation Trust, London, UK.
Ann Med Surg (Lond). 2015 Aug 28;4(3):301-5. doi: 10.1016/j.amsu.2015.08.007. eCollection 2015 Sep.
The use of intraoperative PTH monitoring (IOPTH) in combination with preoperative imaging has been useful to surgeons performing minimally invasive parathyroidectomy principally for adequacy of excision. However, its role within patients with equivocal imaging remains less clear particularly regarding the reduction of bilateral neck explorations. This study investigated the influence of IOPTH monitoring on the type of surgical approach adopted for patients with primary hyperparathyroidism (PHPT). Specifically, determining its impact amongst patients with equivocal imaging results.
165 patients undergoing parathyroidectomy for PHPT at a single institution by a single surgeon, between 2008 and 2012, were included. Patients were divided into 2 groups, IOPTH monitoring and non-IOPTH monitoring. They were sub-classified according to their imaging strengths: strongly positive, equivocal and negative imaging. The percentages of patients undergoing focused, unilateral and bilateral operations were determined.
108 patients had IOPTH monitoring and 57 patients did not based on the availability of IOPTH monitoring. Patients with strongly positive imaging had a higher frequency of focused operation in both groups; IOPTH 73.4% and non-IOPTH 71.4%. Patients with negative imaging results had a higher frequency of bilateral operations; IOPTH 77.8% and non-IOPTH 72.7%. In patients with equivocal imaging results more focused/unilateral operations were performed with IOPTH monitoring 66.6% versus non-IOPTH 25%. The use of intraoperative PTH increased the likelihood of a unilateral procedure with equivocal imaging compared to those with negative imaging p = 0.04.
IOPTH monitoring is most useful as an adjunct to preoperative imaging when imaging results are equivocal allowing for more focused/unilateral operations to be performed.
术中甲状旁腺激素监测（IOPTH）与术前影像学检查相结合，对主要进行微创甲状旁腺切除术的外科医生确定切除是否充分很有帮助。然而，其在影像学检查结果不明确的患者中的作用仍不太清楚，尤其是在减少双侧颈部探查方面。本研究调查了IOPTH监测对原发性甲状旁腺功能亢进症（PHPT）患者所采用手术方式的影响。具体而言，确定其在影像学检查结果不明确的患者中的影响。
纳入2008年至2012年间在单一机构由一名外科医生为PHPT患者进行甲状旁腺切除术的165例患者。患者分为两组，即IOPTH监测组和非IOPTH监测组。根据其影像学优势进一步细分：影像学检查结果强阳性、不明确和阴性。确定接受聚焦手术、单侧手术和双侧手术的患者百分比。
根据IOPTH监测的可用性，108例患者进行了IOPTH监测，57例患者未进行。两组中影像学检查结果强阳性的患者进行聚焦手术的频率更高；IOPTH组为73.4%，非IOPTH组为71.4%。影像学检查结果为阴性的患者进行双侧手术的频率更高；IOPTH组为77.8%，非IOPTH组为72.7%。在影像学检查结果不明确的患者中，接受IOPTH监测的患者进行更多聚焦/单侧手术的比例为66.6%，而未接受IOPTH监测的患者为25%。与影像学检查结果为阴性的患者相比，术中使用PTH增加了影像学检查结果不明确时进行单侧手术的可能性，p = 0.04。
当影像学检查结果不明确时，IOPTH监测作为术前影像学检查的辅助手段最有用，可使更多聚焦/单侧手术得以进行。
