行业技巧：再次甲状旁腺切除术的术前定位技术。
Tricks of the trade: Techniques for preoperative localization in reoperative parathyroidectomy.
机构信息
Department of Surgery, Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA.
Department of Radiology, Division of Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, USA.
出版信息
Am J Surg. 2023 Aug;226(2):207-212. doi: 10.1016/j.amjsurg.2023.04.005. Epub 2023 Apr 12.
BACKGROUND
Reoperative parathyroidectomy for recurrent/persistent primary hyperparathyroidism (PHPT) has high rates of failure. The goal of this study was to analyze our experience with imaging and parathyroid vein sampling (PAVS) for recurrent/persistent PHPT.
METHODS
We performed a retrospective cohort study (2002-2018) of patients with recurrent/persistent PHPT undergoing reoperative parathyroidectomy.
RESULTS
Among 181 patients, the most common imaging study was sestamibi (89.5%), followed by ultrasound (75.7%). CT had the highest rate of localization (70.8%) compared to sestamibi (58.0%) and ultrasound (47.4%). PAVS was performed in 25 patients, and localized in 96%. Ultrasound and sestamibi both demonstrated 62% PPV for operative pathology, compared to 41% in CT. PAVS was 95% sensitive with 95% PPV for predicting the correct side of abnormal parathyroid tissue.
CONCLUSIONS
We recommend a sequential imaging evaluation for reoperative parathyroidectomy, with sestamibi and/or ultrasound followed by CT. PAVS should be considered if non-invasive imaging fails to localize.
背景
复发性/持续性原发性甲状旁腺功能亢进症（PHPT）的再次甲状旁腺切除术失败率较高。本研究旨在分析我们在复发性/持续性 PHPT 中进行影像学和甲状旁腺静脉采血（PAVS）的经验。
方法
我们对 181 例复发性/持续性 PHPT 行再次甲状旁腺切除术的患者进行了回顾性队列研究（2002-2018 年）。
结果
在 181 例患者中，最常见的影像学研究是 sestamibi（89.5%），其次是超声（75.7%）。与 sestamibi（58.0%）和超声（47.4%）相比，CT 的定位率最高（70.8%）。25 例患者行 PAVS，96%定位。超声和 sestamibi 对手术病理的阳性预测值均为 62%，而 CT 为 41%。PAVS 预测异常甲状旁腺组织的正确侧别具有 95%的敏感性和 95%的阳性预测值。
结论
我们建议对再次甲状旁腺切除术进行顺序影像学评估，先进行 sestamibi 和/或超声检查，然后进行 CT 检查。如果非侵入性影像学检查未能定位，应考虑行 PAVS。
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