Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
J Surg Res. 2019 Nov;243:380-383. doi: 10.1016/j.jss.2019.04.084. Epub 2019 Jul 2.
Parathyroidectomy for patients with secondary hyperparathyroidism (sHPT) generally requires a four-gland exploration. Some groups have strongly recommended routine preoperative Tc-99m-sestamibi scans; others practice scanning for only selected patients. To determine the utility of sestamibi scans in this patient population, we reviewed our experience.
We performed a retrospective review of patients who underwent parathyroidectomy for sHPT by one surgeon between 2000 and 2018. Data reviewed included patient demographics, laboratory results, pathology and radiology reports, and clinical and operative notes.
Of the 72 patients in the cohort, mean age was 47.2 ± 15.6, and 50% were female. The preoperative mean calcium and parathyroid hormone levels were 9.6 ± 1.1 mg/dL and 1192.1 ± 914.1 pg/mL, respectively. Sestamibi scans were performed in 21 patients (29%). Of these, 17 were reoperative cases. Of all sHPT patients, 27.8% had ectopic glands. In the sestamibi cohort, only four patients had ectopic glands identified on the scan. Among the 51 patients without preoperative imaging, 16 had ectopic glands (26.2% of nonimaged patients). All these 16 ectopic glands were found by the surgeon at the time of operation without the need for preoperative imaging. All patients in the series were cured with a minimum follow-up of 6 mo.
Ectopic parathyroid glands are commonly seen in patients undergoing parathyroidectomy for sHPT. The majority of ectopic glands were successfully identified during the operation without preoperative sestamibi scan. Therefore, routine preoperative Tc-99m-sestamibi scans are not needed for successful parathyroidectomy for sHPT.
对于患有继发性甲状旁腺功能亢进症（sHPT）的患者，甲状旁腺切除术通常需要进行四腺探查。一些小组强烈建议常规进行术前 Tc-99m-甲氧基异丁基异腈扫描；而另一些小组仅对选定的患者进行扫描。为了确定 sestamibi 扫描在该患者人群中的应用价值，我们回顾了我们的经验。
我们对一位外科医生在 2000 年至 2018 年间进行的 sHPT 甲状旁腺切除术的患者进行了回顾性分析。回顾的数据包括患者的人口统计学、实验室结果、病理和放射学报告以及临床和手术记录。
在队列中的 72 名患者中，平均年龄为 47.2±15.6 岁，女性占 50%。术前平均血钙和甲状旁腺激素水平分别为 9.6±1.1mg/dL 和 1192.1±914.1pg/mL。21 名患者（29%）进行了 sestamibi 扫描，其中 17 例为复发性病例。在所有 sHPT 患者中，27.8%存在异位腺体。在 sestamibi 组中，只有 4 名患者在扫描中发现了异位腺体。在没有术前影像学检查的 51 名患者中，有 16 名患者（非影像学检查患者的 26.2%）存在异位腺体。所有这些 16 个异位腺体均在手术时被外科医生发现，而无需进行术前影像学检查。在所有患者中，均在术后 6 个月的随访中治愈。
在接受 sHPT 甲状旁腺切除术的患者中，异位甲状旁腺腺体很常见。大多数异位腺体在手术中成功识别，而无需术前 sestamibi 扫描。因此，对于 sHPT 的成功甲状旁腺切除术，不需要常规进行术前 Tc-99m-甲氧基异丁基异腈扫描。
