Dream Sophie, Lindeman Brenessa, Chen Herbert
Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA.
Clin Med Insights Endocrinol Diabetes. 2019 Aug 14;12:1179551419869917. doi: 10.1177/1179551419869917. eCollection 2019.
Radioguided surgery has been an effective tool for identifying hyperfunctioning parathyroid glands during routine parathyroidectomy for hyperparathyroidism. The purpose of this study was to examine the role of radioguided surgery for the identification of intrathymic parathyroid glands.
Between March 2001 and February 2018, 2291 patients underwent parathyroidectomy by 1 surgeon for primary hyperparathyroidism. Of these patients, 158 (7%) were identified to have an ectopic intrathymic parathyroid gland. All patients underwent radioguided parathyroidectomy. Ex vivo radionuclide counts were used to confirm parathyroid excision with specimen radioactivity of >20% of the background level.
The mean age was 56 ± 1 years with 74% of the patients being female. Preoperatively, 122 patients underwent sestamibi scan, which correctly identified the affected gland 61% of the time. Mean background radionuclide count was 208 ± 7, mean ex vivo radionuclide count was 127 ± 9, with ex vivo counts of removed glands >20% in all patients. All ectopic parathyroid glands were successfully identified using gamma probe. Ex vivo counts found to be significantly higher in patients with adenomas. Patients with parathyroid adenomas also were older in age and had higher preoperative calcium levels. While 10% of patients with primary hyperparathyroidism have hyperplasia, 42% of patients with thymic parathyroids had hyperplasia.
Radioguided parathyroidectomy is useful in detecting ectopic parathyroid glands in the thymus. Patients with hyperplasia disproportionately have clinically significant thymic parathyroid glands.
在甲状旁腺功能亢进症的常规甲状旁腺切除术中，放射性引导手术一直是识别功能亢进甲状旁腺的有效工具。本研究的目的是探讨放射性引导手术在识别胸腺内甲状旁腺中的作用。
2001年3月至2018年2月期间，1名外科医生为2291例原发性甲状旁腺功能亢进患者实施了甲状旁腺切除术。在这些患者中，158例（7%）被确定有异位胸腺内甲状旁腺。所有患者均接受了放射性引导甲状旁腺切除术。采用体外放射性核素计数来确认甲状旁腺切除，标本放射性高于背景水平的20%。
患者平均年龄为56±1岁，74%为女性。术前，122例患者接受了 sestamibi 扫描，其中61%的时间正确识别了受影响的腺体。平均背景放射性核素计数为208±7，平均体外放射性核素计数为127±9，所有患者切除腺体的体外计数均>20%。所有异位甲状旁腺均使用伽马探头成功识别。腺瘤患者的体外计数明显更高。甲状旁腺腺瘤患者年龄也更大，术前钙水平更高。虽然10%的原发性甲状旁腺功能亢进患者有增生，但42%的胸腺甲状旁腺患者有增生。
放射性引导甲状旁腺切除术有助于检测胸腺内的异位甲状旁腺。增生患者中临床上有意义的胸腺甲状旁腺比例过高。
