Salvador Egea Pilar, Blanco Saiz Isabel, Anda Apiñániz Emma, Redondo Expósito Aitor, Erce García Cristina, Pérez Otermin Irati, Cruz Vásquez Naomi
Unidad de Cirugía Endocrina, Servicio de Cirugía General, Hospital Universitario de Navarra, Pamplona, Spain.
Servicio de Medicina Nuclear, Hospital Universitario de Navarra, Pamplona, Spain.
Cir Esp (Engl Ed). 2025 Mar;103(3):127-134. doi: 10.1016/j.cireng.2024.12.005. Epub 2024 Dec 20.
To evaluate whether a radioguided approach allows a higher intraoperative detection rate of adenoma and a minimally invasive parathyroidectomy (MIP), with the same or better cure rate of hyperparathyroidism secondary to parathyroid adenoma.
This was an observational, prospective, single-center study involving 254 consecutive patients with primary hyperparathyroidism, between 2017 and 2022. A total of 258 procedures were performed: 129 non radioguided (NRS) and 129 radioguided (RS) (112 with intravenous 99mTc- MIBI and 17 with ultrasound-guided intralesional 99mTc-MAA injection) with an intraoperative gamma probe and gamma camera. Follow-up was performed for at least one year.
There were no differences between the groups in terms of age, sex, preoperative calcium or parathyroid hormone levels, adenoma localization with 99mTc-MIBI-gammagraphy and ultrasound, and surgical morbidity. Intraoperative surgical localization was 97.7% in both groups. Statistically significant differences supported RS: It allowed to perform MIP (RS: 96.9%, NRS 88.4%; p = 0.015), also in patients with previous neck surgery (RS: 75%, NRS: 28%; p = 0.019) and with ectopic adenomas (RS: 93.3%, NRS: 71.4%; p = 0.012). The operative time was significantly shorter (RS: 51 min, NRS: 59.79 min; p = 0.005). There were no significant differences in the postoperative complications between the groups. Biochemical cure at six months was achieved in RS: 97.7% and NRS: 93.8% (p = 0.12).
Radioguided MIP is useful in ectopic adenomas and in patients with previous cervical surgery and allows a minimally invasive approach more frequently. It is a safe surgery, easily reproducible by an endocrine surgeon and requires usual equipment found in operating rooms.
评估放射性引导方法是否能提高腺瘤的术中检出率并实现微创甲状旁腺切除术（MIP），同时使甲状旁腺腺瘤继发的甲状旁腺功能亢进症的治愈率相同或更高。
这是一项观察性、前瞻性、单中心研究，纳入了2017年至2022年间连续的254例原发性甲状旁腺功能亢进患者。共进行了258例手术：129例非放射性引导手术（NRS）和129例放射性引导手术（RS）（112例采用静脉注射99mTc-MIBI，17例采用超声引导瘤内注射99mTc-MAA），术中使用γ探头和γ相机。随访至少一年。
两组在年龄、性别、术前钙或甲状旁腺激素水平、99mTc-MIBI闪烁显像和超声检查的腺瘤定位以及手术并发症方面无差异。两组术中手术定位率均为97.7%。支持RS组的统计学显著差异如下：RS组能够实施MIP（RS组：96.9%，NRS组：88.4%；p = 0.015），既往有颈部手术史的患者也是如此（RS组：75%，NRS组：28%；p = 0.019），对于异位腺瘤患者同样如此（RS组：93.3%，NRS组：71.4%；p = 0.012）。手术时间明显更短（RS组：51分钟，NRS组：59.79分钟；p = 0.005）。两组术后并发症无显著差异。RS组六个月时生化治愈情况为：97.7%，NRS组为：93.8%（p = 0.12）。
放射性引导MIP对异位腺瘤以及既往有颈部手术史的患者有用，且更频繁地允许采用微创方法。这是一种安全的手术，内分泌外科医生易于重复操作，并且需要手术室中常见的设备。
