术中甲状旁腺素监测预测正常甲状旁腺功能亢进症患者手术成功率。
Intraoperative parathormone monitoring to predict operative success in patients with normohormonal hyperparathyroidism.
机构信息
From the Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Fla. (Stuart, Azab); the Division of Surgical Oncology, Department of Surgery, University of British Columbia, Vancouver, BC (Stuart); the Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Fla. (Picado Roque, Lew); and the Division of Surgical Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Pasieka)
From the Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Fla. (Stuart, Azab); the Division of Surgical Oncology, Department of Surgery, University of British Columbia, Vancouver, BC (Stuart); the Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Fla. (Picado Roque, Lew); and the Division of Surgical Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Pasieka).
出版信息
Can J Surg. 2022 Jul 28;65(4):E468-E473. doi: 10.1503/cjs.013220. Print 2022 Jul-Aug.
BACKGROUND
It is unclear whether parathyroidectomy guided by intraoperative parathormone (PTH) monitoring is predictive of operative success in patients with normohormonal hyperparathyroidism (nhHPT), a variant of primary hyperparathyroidism (pHPT) in which patients develop clinical manifestations similar to those of pHPT. This study examined intraoperative PTH monitoring in patients undergoing parathyroidectomy for nhHPT.
METHODS
We performed a retrospective review of prospectively collected data from adult (age > 18 yr) patients who underwent parathyroidectomy for pHPT at 1 of 2 North American medical centres (in Calgary, Alberta, Canada, or Miami, Florida, United States) between 2007 and 2015. In patients with nhHPT, we used the criterion of an intraoperative decrease of more than 50% in PTH after abnormal gland excision. We defined operative success as continuous eucalcemia more than 6 months after parathyroidectomy.
RESULTS
Of 333 patients, 38 (11.4%) had nhHPT, with mean preoperative calcium and PTH levels of 2.7 mmol/L and 53 pg/dL, respectively. An intraoperative decrease of more than 50% in PTH level was seen in 27 patients (71.0%) with nhHPT and 265 patients (89.8%) with classic pHPT at 5 minutes ( < 0.001); the corresponding values at 20 minutes were 35 (92.1%) and 286 (96.9%). Although 5 patients (13.2%) with nhHPT did not reach this criterion until 20 minutes, the rate of operative success was still 97.0% at long-term follow-up (mean 13 mo, range 6-67 mo). Of the 38 patients, 3 (7.9%) did not have an intraoperative decrease of more than 50% in PTH level by 20 minutes. Two of the 3 achieved operative success and remained normocalemic, and 1 developed recurrent disease at 12 months.
CONCLUSION
Parathyroidectomy guided by intraoperative PTH monitoring accurately predicted operative success in patients with nhHPT. Intraoperative PTH monitoring may also help identify multiglandular disease in patients with nhHPT, using criteria similar to those in classic pHPT, with comparable operative success.
背景
在正常甲状旁腺激素（PTH）水平的甲状旁腺功能亢进症（nhHPT）患者中，甲状旁腺切除术是否能预测手术成功尚不清楚。nhHPT 是原发性甲状旁腺功能亢进症（pHPT）的一种变异，其患者表现出与 pHPT 相似的临床表现。本研究检测了接受甲状旁腺切除术的 nhHPT 患者的术中 PTH 监测。
方法
我们对 2007 年至 2015 年期间在加拿大阿尔伯塔省卡尔加里和美国佛罗里达州迈阿密的 2 个北美医疗中心接受 pHPT 甲状旁腺切除术的成年（年龄＞18 岁）患者前瞻性收集的数据进行了回顾性分析。在 nhHPT 患者中，我们使用术中异常腺体切除后 PTH 下降超过 50%的标准。我们将手术成功定义为甲状旁腺切除术后 6 个月以上持续血钙正常。
结果
在 333 例患者中，38 例（11.4%）患有 nhHPT，术前血钙和 PTH 水平分别为 2.7mmol/L 和 53pg/dL。27 例（71.0%）nhHPT 患者和 265 例（89.8%）经典 pHPT 患者在 5 分钟时 PTH 水平下降超过 50%（＜0.001）；20 分钟时相应值分别为 35（92.1%）和 286（96.9%）。尽管 5 例（13.2%）nhHPT 患者直到 20 分钟才达到这一标准，但长期随访（平均 13 个月，范围 6-67 个月）的手术成功率仍为 97.0%。在 38 例患者中，有 3 例（7.9%）在 20 分钟时 PTH 水平下降未超过 50%。其中 2 例患者手术成功并保持血钙正常，1 例患者在 12 个月时复发疾病。
结论
术中 PTH 监测可准确预测 nhHPT 患者的手术成功。术中 PTH 监测也可以帮助识别 nhHPT 患者的多腺体疾病，使用与经典 pHPT 相似的标准，具有相似的手术成功率。
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