Division of General Surgery, Department of Medical, Surgical and Health Sciences, Cattinara Teaching Hospital, Strada di Fiume, 34149, Trieste, Italy.
Division of Laboratory Medicine - Cattinara Teaching Hospital, Strada di Fiume, 34149, Trieste, Italy.
Int J Surg. 2017 May;41 Suppl 1:S26-S33. doi: 10.1016/j.ijsu.2017.02.063.
The main goal of our study was to confirm the usefulness of intra-operative parathyroid hormone (PTH) monitoring (ioPTH) when using minimally invasive techniques for treatment of sporadic Primary hyperparathyroidism (pHTP). Furthermore, we aimed to evaluate if ioPTH monitoring may help to predict the etiology of primary hyperparathyroidism, especially in malignant or multiglandular parathyroid disease.
A retrospective review of 125 consecutive patients with pHPT who underwent parathyroidectomy between 2001 and 2016 at the Department of General Surgery was performed. For each patient, the specific preoperative work-up consisted of: high-resolution US of the neck by a skilled sonographer, sestamibi parathyroid scan, laryngoscopy, and serum measurement of PTH, serum calcium levels, and serum 25(OH)D levels.
The study included 125 consecutive patients who underwent surgery for pHPT. At the histological examination, we registered 113 patients with simple adenomatous pathology (90,4%), 5 atypical adenomas (4%), 3 cases of parathyroid carcinoma (2,4%),, , and 4 histological exams of different nature (3,2%). Overall, 6 cases (4,8%) of multiglandular disease were found. We reported 10 cases (8%) of recurrent/persistent hyperparathyroidism: 1/10 in a patient affected by atypical adenoma, 9/10 in patients with benign pathology. Regarding these 10 cases, in three (30%) patients, ioPTH wasn't dosed (only frozen section (FS) exam was taken), in 5 cases (50%) ioPTH dropped more than 50% compared to basal value (false negative results), and in 2 (20%) cases, ioPTH did not drop >50% from the first samples taken, the extemporary exam had confirmed the presence of adenoma and the probable second hyperfunctioning adenoma was not found.
IoPTH determinations ensure operative success of surgical resection in almost all hyperfunctioning tissue; in particular it is very important during minimally invasive parathyroidectomy, as it allows avoiding bilateral neck exploration. The use of ioPTH monitoring offer increased sensitivity in detecting multiglandular disease and can minimize the need and risk associated with recurrent operations, and may facilitate cost-effective minimally invasive surgery. Moreover, intraoperative PTH monitoring could be a reliable marker to predict a malignant disease during parathyroidectomy, showing higher ioPTH baseline value and superior drop compared to benign disease.
我们研究的主要目的是确认术中甲状旁腺激素（ioPTH）监测在使用微创技术治疗散发性原发性甲状旁腺功能亢进症（pHPT）时的有效性。此外，我们旨在评估 ioPTH 监测是否有助于预测原发性甲状旁腺功能亢进症的病因，尤其是在恶性或多腺体甲状旁腺疾病中。
回顾性分析了 2001 年至 2016 年间在普外科接受甲状旁腺切除术的 125 例 pHPT 连续患者。每位患者的具体术前检查包括：由熟练的超声医师进行颈部高分辨率超声检查、锝 99m 甲氧基异丁基异腈甲状旁腺扫描、喉镜检查以及甲状旁腺激素、血清钙和血清 25（OH）D 水平的检测。
本研究纳入了 125 例接受 pHPT 手术的连续患者。在组织学检查中，我们发现 113 例患者为单纯腺瘤性病变（90.4%）、5 例不典型腺瘤（4%）、3 例甲状旁腺癌（2.4%）和 4 例不同性质的组织学检查（3.2%）。总体而言，发现 6 例（4.8%）多腺体疾病。我们报告了 10 例（8%）复发性/持续性甲状旁腺功能亢进症：1/10 例发生在患有不典型腺瘤的患者中，9/10 例发生在良性病变患者中。关于这 10 例患者，在 3 例（30%）患者中，未检测到 ioPTH（仅进行了冰冻切片检查），在 5 例（50%）患者中，ioPTH 较基础值下降超过 50%（假阴性结果），在 2 例（20%）患者中，首次采集的样本中 ioPTH 未下降>50%，临时检查证实了腺瘤的存在，并且可能没有发现第二个功能亢进的腺瘤。
ioPTH 测定可确保手术切除功能性亢进组织的手术成功率；在微创甲状旁腺切除术期间，它非常重要，因为它可以避免双侧颈部探查。使用 ioPTH 监测可以提高检测多腺体疾病的敏感性，并最大限度地减少与复发性手术相关的风险，并可能有助于具有成本效益的微创手术。此外，术中甲状旁腺激素监测可以成为甲状旁腺切除术期间预测恶性疾病的可靠标志物，显示出比良性疾病更高的 ioPTH 基线值和更大的下降幅度。
