Mallette L E, Malini S
Department of Internal Medicine, Baylor College of Medicine, Houston, Texas.
Am J Med Sci. 1989 Jul;298(1):51-8. doi: 10.1097/00000441-198907000-00010.
High-resolution, real-time sonography can be used to assess the size and location of the parathyroid glands. The authors review the types of information provided by sonography and outline the ways in which it contributes to the management of primary hyperparathyroidism. Sonography usually can differentiate parathyroid adenoma from hyperplasia. In milder cases, with less parathyroid enlargement, this differentiation is difficult but can be facilitated by determining three dimensions for each gland. Preoperative knowledge of the presumptive location of an adenoma is most useful when the strategy of unilateral neck exploration is to be used because it will allow the exploration always to begin on the correct side. Sonographic evidence of hyperplasia should trigger a preoperative search for multiple endocrine neoplasia and will alert the surgeon that a bilateral neck exploration and thymectomy will be needed. A more universal benefit is the ability to predict or exclude intrathyroidal and subcapsular parathyroid tumors, thus guiding the decision for thyroid versus thymic exploration in the event of a missing abnormal gland. Sonography often fails to visualize parathyroid tumors in an ectopic position away from the thyroid bed. Such tumors, however, may be anticipated when the sonogram shows only three enlarged glands in cases of hyperplasia, or only three glands of normal size in a patient with strong biochemical evidence of hyperparathyroidism. Because it is noninvasive and inexpensive and can provide a wealth of information, the authors have adopted sonography as a routine preoperative procedure for primary hyperparathyroidism.
高分辨率实时超声检查可用于评估甲状旁腺的大小和位置。作者回顾了超声检查所提供的信息类型，并概述了其在原发性甲状旁腺功能亢进症管理中的作用方式。超声检查通常能够区分甲状旁腺腺瘤和增生。在病情较轻、甲状旁腺肿大程度较小的情况下，这种区分较为困难，但通过确定每个腺体的三维尺寸可有助于区分。当采用单侧颈部探查策略时，术前了解腺瘤的推测位置最为有用，因为这能使探查始终从正确的一侧开始。增生的超声证据应促使术前对多发性内分泌肿瘤进行排查，并提醒外科医生需要进行双侧颈部探查和胸腺切除术。一个更普遍的好处是能够预测或排除甲状腺内和甲状腺包膜下的甲状旁腺肿瘤，从而在未发现异常腺体的情况下指导甲状腺探查与胸腺探查的决策。超声检查常常无法显示位于远离甲状腺床的异位位置的甲状旁腺肿瘤。然而，当超声检查在增生病例中仅显示三个增大的腺体，或者在有强烈生化证据表明患有甲状旁腺功能亢进症的患者中仅显示三个正常大小的腺体时，可能会预期存在此类肿瘤。由于超声检查是非侵入性的且成本低廉，并且能够提供大量信息，作者已将超声检查作为原发性甲状旁腺功能亢进症的常规术前检查方法。
