Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Endocrine Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Int J Surg. 2017 Mar;39:229-233. doi: 10.1016/j.ijsu.2017.02.009. Epub 2017 Feb 10.
Surgical resection of the abnormal parathyroid glands is the only curative treatment for primary hyperparathyroidism (PHPT). Radioguided parathyroidectomy with technetium-99m (TC-99m) sestamibi has been successfully used in patients with PHPT. This study was designed to evaluate the results of a series of patients with PHPT who underwent minimally invasive radioguided parathyroidectomy (MIRP) using very low dose (1 mCi) of TC-99m sestamibi (MIBI) without application of intraoperative parathyroid hormone (PTH) assay or frozen section analysis.
Eighty-seven patients with PHPT were prospectively studied from November 2012 to January 2015. Following neck ultrasound (US) and MIBI scan concordant for single gland disease, patients underwent MIRP using a handheld gamma probe. The technique involved injecting of 1 mCi MIBI in the operative room before the beginning of the intervention. All patients were followed up for a minimum of 6 months postoperatively.
MIRP was successfully performed in 86 out of 87 patients (98.85%). The Gamma probe was particularly useful in detection of ectopic parathyroid adenomas in upper mediastinum. Mean operative time was 23.95 ± 7.982 min and mean hospital stay was 1.44 ± 0.604 days. No major surgical complications were recorded.
The MIRP technique using very low dose (1 mCi) of Tc-99m MIBI without intraoperative PTH assay and frozen section analysis resulted in excellent cure rate for PHPT. This technique involves a radiation exposure to patients and surgical staffs 20 times lower than conventional MIRP using 20 mCi Tc-99m MIBI. Besides, patients with PHPT due to ectopic parathyroid adenoma may especially benefit from MIRP.
外科切除异常甲状旁腺是原发性甲状旁腺功能亢进症（PHPT）的唯一治愈性治疗方法。锝-99m（Tc-99m） sestamibi 放射性导向甲状旁腺切除术已成功用于 PHPT 患者。本研究旨在评估一组接受微创放射性导向甲状旁腺切除术（MIRP）的 PHPT 患者的结果，这些患者使用非常低剂量（1mCi）的 Tc-99m sestamibi（MIBI），而不应用术中甲状旁腺激素（PTH）测定或冷冻切片分析。
从 2012 年 11 月至 2015 年 1 月，前瞻性研究了 87 例 PHPT 患者。在颈部超声（US）和 MIBI 扫描均提示单腺疾病后，患者在手术室中注射 1mCi MIBI 后行 MIRP。该技术包括在干预开始前在手术室注射 1mCi MIBI。所有患者均在术后至少随访 6 个月。
87 例患者中有 86 例（98.85%）成功进行了 MIRP。伽马探针在检测上纵隔异位甲状旁腺瘤方面特别有用。平均手术时间为 23.95±7.982 分钟，平均住院时间为 1.44±0.604 天。未记录到主要手术并发症。
使用非常低剂量（1mCi）Tc-99m MIBI 且不进行术中 PTH 测定和冷冻切片分析的 MIRP 技术可使 PHPT 的治愈率非常高。与使用 20mCi Tc-99m MIBI 的传统 MIRP 相比，该技术使患者和外科医生的辐射暴露降低了 20 倍。此外，异位甲状旁腺腺瘤引起的 PHPT 患者可能特别受益于 MIRP。
