Head and Neck Surgery, Department of Surgery, Parathyroid Unit (LIM 28), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil.
Head and Neck Surgery, Department of Surgery, Parathyroid Unit (LIM 28), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil.
Surgery. 2020 Dec;168(6):1079-1085. doi: 10.1016/j.surg.2020.06.043. Epub 2020 Aug 15.
This study aims to determine whether intraoperative parathyroid hormone monitoring helps to predict early surgical outcomes in patients with renal hyperparathyroidism and evaluate the impact on decision making during surgery.
A prospective study was conducted. Serial samples of the intraoperative parathyroid hormone were collected; 2 of these were taken before the excision, and 2 were taken after the planned parathyroid resection (10 minutes and 15 minutes). We tested the criterion of an intraoperative parathyroid hormone percentage decay ≥80% of the highest value of the basal samples as a predictor of success.
Of the 228 patients, parathyroidectomy achieved success in 92.1%. In patients with secondary hyperparathyroidism, the failure group showed a tendency to stabilize or even increase the intraoperative parathyroid hormone values from the 10-minute measure (577 pg/mL) to the 15-minute measure (535 pg/mL) (P = .903). Conversely, intraoperative parathyroid hormone continued to drop in those with a successful outcome: 245 pg/mL (10 minutes) and 206 pg/mL (15 minutes) (P < .001). The failure group had a significantly lower percentage decay (P < .001) from baseline when compared with the success group. The intraoperative parathyroid hormone influenced the surgical management in up to 7% of the cases. The intraoperative parathyroid hormone dosage method showed an accuracy of 86%, a sensitivity of 88%, and specificity of 67%.
In patients with renal hyperparathyroidism undergoing parathyroidectomy, the use of intraoperative parathyroid hormone may help to predict an early therapeutic outcome with high sensitivity and accuracy by indicating the operation's success when there is an 80% reduction of baseline intraoperative parathyroid hormone 15 minutes after removal of the enlarged glands, an associated continuous decrease in serum intraoperative parathyroid hormone levels between 10 and 15 minutes, and achievement of plasma target values <500 pg/mL.
本研究旨在确定术中甲状旁腺激素监测是否有助于预测肾性甲状旁腺功能亢进症患者的早期手术结果，并评估其对手术决策的影响。
进行了一项前瞻性研究。收集术中甲状旁腺激素的连续样本；其中 2 个在切除前采集，2 个在计划的甲状旁腺切除后采集（10 分钟和 15 分钟时）。我们测试了术中甲状旁腺激素百分比下降≥基础样本中最高值的 80%作为成功预测指标的标准。
在 228 例患者中，甲状旁腺切除术成功率为 92.1%。在继发性甲状旁腺功能亢进患者中，失败组的术中甲状旁腺激素值从 10 分钟测量（577 pg/mL）到 15 分钟测量（535 pg/mL）有趋于稳定甚至增加的趋势（P=.903）。相反，在成功组中，术中甲状旁腺激素持续下降：245 pg/mL（10 分钟）和 206 pg/mL（15 分钟）（P <.001）。与成功组相比，失败组的基线下降百分比明显较低（P <.001）。术中甲状旁腺激素在多达 7%的病例中影响了手术管理。术中甲状旁腺激素检测方法的准确性为 86%，敏感性为 88%，特异性为 67%。
在接受甲状旁腺切除术的肾性甲状旁腺功能亢进症患者中，使用术中甲状旁腺激素可以通过在切除增大的腺体后 15 分钟时基线术中甲状旁腺激素降低 80%、10 至 15 分钟之间血清术中甲状旁腺激素水平持续下降以及达到血浆靶值<500 pg/mL 来预测手术的成功，从而具有较高的敏感性和准确性。
