Aygün Nurcihan, Uludağ Mehmet
Department of General Surgery, Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Sisli Etfal Hastan Tip Bul. 2019 Jul 11;53(2):84-95. doi: 10.14744/SEMB.2019.37542. eCollection 2019.
Primary hyperparathyroidism (pHPT) is a frequently seen endocrine disease, and its main treatment is surgery. In the majority of pHPT, the disease involves only a single gland, and the majority of the pathological glands can be determined by preoperative localization methods.In addition to preoperative localization studies in parathyroidectomy, the use of adjunct methods to improve intraoperative localization in order to increase success of surgery is becoming widespread. These methods include different approaches, mainly intraoperative parathyroid hormone (PTH) measurement, followed by intraoperative gamma probe application, intraoperative ultrasonography, parathyroid imaging with methylene blue, and frozen section examination. Recently, especially promising new imaging methods have been described in the literature with various optical technologies to increase the localization of the parathyroid glands and to evaluate their viability. These methods include parathyroid imaging with autofluorescence, indocyanine green imaging with autofluorescence, autofluorescence imaging with methylene blue, autofluorescence imaging with 5-aminolevulinic acid, optical coherence tomography, laser speckle contrast imaging, dynamic optical contrast imaging, and Raman spectroscopy. Currently, minimally invasive parathyroidectomy has become the standard treatment for selected pHPT patients with the aid of preoperative imaging and intraoperative auxiliary methods . The aim of the present study was to evaluate the routinely used new promising intraoperative adjunct methods in pHPT.
原发性甲状旁腺功能亢进症（pHPT）是一种常见的内分泌疾病，其主要治疗方法是手术。在大多数pHPT病例中，病变仅累及单个腺体，并且大多数病理性腺体可通过术前定位方法确定。除了甲状旁腺切除术中的术前定位研究外，使用辅助方法来改善术中定位以提高手术成功率的做法正变得越来越普遍。这些方法包括不同的途径，主要是术中甲状旁腺激素（PTH）测量，其次是术中γ探头应用、术中超声检查、亚甲蓝甲状旁腺成像以及冰冻切片检查。最近，文献中描述了一些特别有前景的新成像方法，这些方法采用各种光学技术来提高甲状旁腺的定位并评估其活力。这些方法包括自体荧光甲状旁腺成像、吲哚菁绿自体荧光成像、亚甲蓝自体荧光成像、5-氨基酮戊酸自体荧光成像、光学相干断层扫描、激光散斑对比成像、动态光学对比成像以及拉曼光谱。目前，借助术前成像和术中辅助方法，微创甲状旁腺切除术已成为选定pHPT患者的标准治疗方法。本研究的目的是评估pHPT中常规使用的有前景的新型术中辅助方法。
