原发性甲状旁腺功能亢进症术中甲状旁腺激素测定的成本效益分析

Cost-benefit analysis of the intraoperative parathyroid hormone assay in primary hyperparathyroidism.

作者信息

Badii Benedetta, Staderini Fabio, Foppa Caterina, Tofani Lorenzo, Skalamera Ileana, Fiorenza Giulia, Qirici Eva, Cianchi Fabio, Perigli Giuliano

机构信息

Unit of General and Endocrine Surgery, Center of Oncological and Minimally Invasive Surgery, Department of Surgery and Translational Medicine, University of Florence, Italy.

Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Clinical Trials Coordinating Center, Istituto Toscano Tumori, Florence, Italy.

出版信息

Head Neck. 2017 Feb;39(2):241-246. doi: 10.1002/hed.24567. Epub 2016 Aug 24.

DOI:10.1002/hed.24567

PMID:27557453

Abstract

BACKGROUND

The purpose of this study was to evaluate the usefulness of the routine intraoperative intact parathyroid hormone (IOPTH) assay, the role of unilateral and bilateral cervical exploration and of preoperative imaging, and to do a cost-benefit analysis in parathyroidectomy for primary hyperparathyroidism.

METHODS

Two hundred sixty-four patients who underwent operations between January 2000 and March 2015 were retrospectively divided into 2 groups.

RESULTS

Group A (IOPTH) was composed of 64 patients. Ultrasonography and technetium-99m-sestamibi (MIBI) identified the adenoma in 38 cases. Bilateral exploration was performed in 43 patients; of which 2 failures occurred. The IOPTH false-negative rate was 18.4%. The average cost was €1297.30. Group B (without IOPTH) was composed of 200 patients. Ultrasonography and MIBI identified the adenoma in 113 cases. Bilateral exploration was performed in 129 patients; of which 2 failures occurred. The average cost was €618.75.

CONCLUSION

The IOPTH assay should be used only in few selected cases because of its high cost. The experience of the team is essential to obtain a high cure rate. © 2016 Wiley Periodicals, Inc. Head Neck 39: 241-246, 2017.

摘要

背景

本研究旨在评估术中常规甲状旁腺激素（IOPTH）测定的实用性、单侧及双侧颈部探查和术前影像学检查的作用，并对原发性甲状旁腺功能亢进症甲状旁腺切除术进行成本效益分析。

方法

回顾性分析2000年1月至2015年3月期间接受手术的264例患者，并将其分为两组。

结果

A组（使用IOPTH）64例患者。超声和99m锝-甲氧基异丁基异腈（MIBI）共识别出38例腺瘤。43例患者进行了双侧探查，其中2例探查失败。IOPTH假阴性率为18.4%。平均费用为1297.30欧元。B组（未使用IOPTH）200例患者。超声和MIBI共识别出113例腺瘤。129例患者进行了双侧探查，其中2例探查失败。平均费用为618.75欧元。