甲状旁腺手术中的诊断和治疗决定因素：一项回顾性队列研究。
Diagnostic and therapeutic determinants in parathyroid surgery: A retrospective cohort study.
作者信息
Sbai Achraf Amine, Tsen Adil Abdenbi, Elayoubi Fahd
机构信息
Department of Ear Nose and Throat, Mohammed VI University Hospital, Medical School, Mohammed the First University, Oujda, Morocco.
Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed the First University, Morocco.
出版信息
Ann Med Surg (Lond). 2022 Sep 27;82:104751. doi: 10.1016/j.amsu.2022.104751. eCollection 2022 Oct.
INTRODUCTION
The systematic realization of biochemical and radiological examinations of the parathyroid has increased the incidence of primary hyperparathyroidism; which explains the increasing incidence of parathyroid surgery. Our study aims to predict the factors determining the diagnosis and management of parathyroid adenomas.
METHODS
We included 87 patients who presented with hyperparathyroidism and underwent parathyroid surgery. Ultrasound, computed tomography (CT), and more rarely sestamibi, were performed to localize the lesion preoperatively. Body mass index (BMI), blood and urine calcium and PTH concentrations before and after surgery, and preoperative vitamin D concentrations were evaluated.
RESULTS
In 90.8% of the cases, the location of the adenomas was retained thanks to cervical ultrasound, and in 86% of the cases, the ultrasound results were concordant with the intraoperative results, whereas the MIBI scanner was used in only 6 patients with a specificity and sensitivity of 100%, but these results cannot be taken into account because the sample is too small. No significant association was found between weight and preoperative vitamin D concentration, whereas we find a positive correlation between preoperative vitamin D concentration and adenoma weight (p = 0.001). Postoperative follow-up showed a positive relationship between the onset of hypocalcemia and vitamin D deficiency, and an inverse correlation between PTH concentration and postoperative hypocalcemia. All patients with an unknown vitamin profile (n:4) who developed postoperative hypocalcemia had a BMI greater than 25 kg/m2. The higher the PTH concentration in the preoperative period, the more profound the hypocalcemia.
CONCLUSION
Further studies are needed to explore the role of vitamin D in the localization of parathyroid adenomas on the one hand, and to properly document the association between BMI and preoperative PTH concentration on the other.
引言
甲状旁腺生化和放射学检查的系统开展增加了原发性甲状旁腺功能亢进症的发病率；这也解释了甲状旁腺手术发病率的上升。我们的研究旨在预测决定甲状旁腺腺瘤诊断和治疗的因素。
方法
我们纳入了87例患有甲状旁腺功能亢进症并接受甲状旁腺手术的患者。术前进行超声、计算机断层扫描（CT），较少进行甲氧基异丁基异腈（sestamibi）检查以定位病变。评估了体重指数（BMI）、手术前后的血钙和甲状旁腺激素（PTH）浓度以及术前维生素D浓度。
结果
在90.8%的病例中，通过颈部超声确定了腺瘤的位置，86%的超声结果与术中结果一致，而仅6例患者使用了甲氧基异丁基异腈扫描，其特异性和敏感性均为100%，但由于样本量过小，这些结果不予考虑。体重与术前维生素D浓度之间未发现显著关联，而我们发现术前维生素D浓度与腺瘤重量之间呈正相关（p = 0.001）。术后随访显示低钙血症的发生与维生素D缺乏呈正相关，PTH浓度与术后低钙血症呈负相关。所有术后发生低钙血症且维生素状况未知的患者（n = 4）的BMI均大于25 kg/m²。术前PTH浓度越高，低钙血症越严重。
结论
一方面需要进一步研究探索维生素D在甲状旁腺腺瘤定位中的作用，另一方面需要正确记录BMI与术前PTH浓度之间的关联。
Zotero 插件