Sreevathsa Maddibande Ramachar, Melanta Khyati
Department of General Surgery, MS Ramaiah Medical College and Hospital, Bangalore, 560094 India.
Department of Surgery, MS Ramaiah Medical College and Hospital, New BEL Road, Bangalore, 560054 India.
Indian J Surg Oncol. 2017 Jun;8(2):142-145. doi: 10.1007/s13193-016-0605-2. Epub 2016 Dec 27.
Between January 2012 to 2016, 20 patients with primary hyperparathyroidism underwent surgical exploration for presumed diagnosis of parathyroid adenoma. Nineteen patients underwent ultrasonography of neck and USG was found to be accurate in localizing the adenoma in 84.2%. Seventeen patients underwent sestamibi isotope scanning and imaging correlated with operative findings in 94.1%. Combined accuracy of ulrasound and sestamibi scan which was done in 17 patients was 95%. Seventeen patients underwent unilateral exploration and there was resolution of disease in 94.1%. Three patients underwent bilateral exploration and had a success rate of 100% in the removal of offending adenoma. Fifteen minutes post excision, rapid intraoperative intact parathormone assay was sent in 14 out of 17 unilateral explorations and was found to have true positive rate of 93% and false positive rate of 7%. There was a significant difference in the operating time between unilateral (17 patients, mean operating time 1 h) and bilateral (3 patients, mean operating time 1¾ hrs) explorations. It is clear from this study; the preoperative localization of adenoma with plan for unilateral exploration with a combination of ultrasonography and sestamibi scan is extremely useful if unilateral exploration is planned for excision of parathyroid adenoma. However, the number of patients who underwent 15 min post excision intact parathormone assay, is a small number to comment on its usefulness in predicting the success of unilateral exploration.
2012年1月至2016年期间，20例原发性甲状旁腺功能亢进患者因疑似甲状旁腺腺瘤接受手术探查。19例患者接受了颈部超声检查，超声检查对腺瘤的定位准确率为84.2%。17例患者接受了锝-99m甲氧基异丁基异腈（sestamibi）同位素扫描，成像与手术结果的相关性为94.1%。17例患者同时进行了超声和sestamibi扫描，联合准确率为95%。17例患者接受了单侧探查，疾病缓解率为94.1%。3例患者接受了双侧探查，切除致病腺瘤的成功率为100%。17例单侧探查中有14例在切除后15分钟进行了术中快速完整甲状旁腺素检测，发现其真阳性率为93%，假阳性率为7%。单侧探查（17例患者，平均手术时间1小时）和双侧探查（3例患者，平均手术时间1.75小时）之间的手术时间存在显著差异。从这项研究可以清楚地看出：如果计划进行单侧探查以切除甲状旁腺腺瘤，联合超声和sestamibi扫描对腺瘤进行术前定位并计划单侧探查非常有用。然而，切除后15分钟进行完整甲状旁腺素检测的患者数量较少，难以对其在预测单侧探查成功方面的有用性进行评论。
