Toriie Sayoko, Sugimoto Takeki, Hokimoto Norihiro, Funakoshi Taku, Ogawa Maho, Oki Toyokazu, Dabanaka Ken, Namikawa Tsutomu, Sakurai Akihiro, Hanazaki Kazuhiro
Department of Surgery, Kochi Medical School, Kochi University, Japan.
Department of Genetic Medicine, Sapporo Medical University, Japan.
Ann Med Surg (Lond). 2016 Mar 10;7:42-7. doi: 10.1016/j.amsu.2016.03.003. eCollection 2016 May.
An accurate differential diagnosis between single adenoma (SA) and multiglandular disease (MGD) remains difficult in Technetium-99m sestamibi scintigraphy (MIBI)-negative patients with primary hyperparathyroidism (PHPT). The aim of the present study was to evaluate the minimally invasive parathyroidectomy (MIP) in patients with PHPT.
Clinical records of 48 patients who underwent neck exploration between November 2002 and June 2012 in Kochi Medical School Hospital were reviewed retrospectively to identify candidates that underwent for MIP which was defined as the selective removal of a SA using less invasive surgery.
The preoperative detection rate of lesions using ultrasonography, MIBI, computed tomography, and magnetic resonance imaging was 90%, 83%, 76%, and 55%, respectively. Although all 39 patients in the MIBI-positive group were diagnosed with an SA and subsequently underwent curative MIP, 3 patients in MIBI-negative group (n = 6) were MGD, who underwent neck exploration. Preoperative mean intact parathyroid hormone (419 pg/ml vs. 149 pg/ml; P < 0.01) and alkaline phosphatase levels (746 U/l vs. 277 U/l; P < 0.01) were significantly higher in the SA than MGD group.
In MIBI-negative patients with indications for surgery, MIP should not be carried out without a clear localization of SA, or in MGD.
对于原发性甲状旁腺功能亢进症（PHPT）且99m锝甲氧基异丁基异腈闪烁扫描（MIBI）结果为阴性的患者，准确鉴别单发性腺瘤（SA）和多腺体疾病（MGD）仍然困难。本研究的目的是评估PHPT患者的微创甲状旁腺切除术（MIP）。
回顾性分析2002年11月至2012年6月在高知医科大学医院接受颈部探查的48例患者的临床记录，以确定接受MIP的患者，MIP定义为采用侵入性较小的手术选择性切除SA。
术前超声、MIBI、计算机断层扫描和磁共振成像对病变的检出率分别为90%、83%、76%和55%。虽然MIBI阳性组的所有39例患者均被诊断为SA，随后接受了根治性MIP，但MIBI阴性组（n = 6）中有3例为MGD，接受了颈部探查。SA组术前平均完整甲状旁腺激素水平（419 pg/ml对149 pg/ml；P < 0.01）和碱性磷酸酶水平（746 U/l对277 U/l；P < 0.01）显著高于MGD组。
对于有手术指征的MIBI阴性患者，若未明确SA的定位或存在MGD，不应进行MIP。
