术前甲状旁腺定位并不能改善原发性甲状旁腺功能亢进症患者的手术结果。
Preoperative parathyroid localization does not improve surgical outcomes for patients with primary hyperparathyroidism.
机构信息
The Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA.
The Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA.
出版信息
Am J Surg. 2020 Sep;220(3):533-535. doi: 10.1016/j.amjsurg.2020.04.029. Epub 2020 Apr 25.
BACKGROUND
Most patients with primary hyperparathyroidism undergo localization prior to operation with variable success. Therefore, in this study we investigated the safety of parathyroidectomy without imaging.
METHODS
A prospective database of 2057 surgical patients with primary hyperparathyroidism from 2001 to 2019 was reviewed. Patients were categorized by use of preoperative imaging (ultrasound, sestamibi, CT scan), pathology, and cure.
RESULTS
1879 (91%) patients underwent preoperative imaging. CT scan was the most sensitive study (92%), though specificity was only 64%. Patients with imaging were older, had higher pre- and postoperative calcium, more likely to undergo unilateral exploration and have an adenoma (p < 0.001-0.038). No differences were seen in nerve injury (<1%), postoperative hypocalcemia (<1%), or cure rate.
CONCLUSIONS
While localization may lead to minimally-invasive operations, we observed no differences in postoperative complications or cure rates in the hands of an experienced surgeon. Therefore, preoperative parathyroid localization does not improve outcomes for hyperparathyroidism and can be ordered sparingly.
背景
大多数原发性甲状旁腺功能亢进症患者在手术前会进行定位，但成功率不一。因此，本研究旨在探讨不进行影像学定位的甲状旁腺切除术的安全性。
方法
回顾 2001 年至 2019 年期间 2057 例原发性甲状旁腺功能亢进症手术患者的前瞻性数据库。根据术前影像学（超声、锝-99m 甲氧基异丁基异腈扫描、CT 扫描）、病理和治愈情况对患者进行分类。
结果
1879 例（91%）患者接受了术前影像学检查。CT 扫描是最敏感的研究（92%），但特异性仅为 64%。接受影像学检查的患者年龄更大，术前和术后血钙水平更高，更有可能进行单侧探查，且更有可能为腺瘤（p<0.001-0.038）。神经损伤（<1%）、术后低钙血症（<1%）或治愈率无差异。
结论
尽管定位可能导致微创手术，但在经验丰富的外科医生手中，我们并未观察到术后并发症或治愈率的差异。因此，甲状旁腺术前定位并不能改善甲状旁腺功能亢进症的治疗效果，应慎重选择。
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