Noori Farshad, Güceoğlu Erdal, Aydoğdu Yunushan Furkan, Büyükkasap Çağrı, Kozan Ramazan, Dikmen Kürşat, Gülbahar Özlem, Akın Murat, Şakrak Ömer
Department of Gastroenterology Surgery, Bilkent City Hospital, Ankara, Turkey.
Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey.
BMC Endocr Disord. 2025 Apr 25;25(1):116. doi: 10.1186/s12902-025-01942-z.
Primary hyperparathyroidism (PHPT) is caused by excessive parathormone secretion from one or more parathyroid glands. The primary treatment for PHPT is surgery. Due to anatomical variations in the parathyroid glands, preoperative localization, surgical approaches, and success rates can vary. With the development of advanced imaging techniques and the introduction of intraoperative intact PTH (i-PTH) measurement, traditional extended surgical approaches have increasingly been replaced by focused surgeries.
Intraoperative i-PTH measurement has been applied by different surgeons using various criteria. This study aims to evaluate the effectiveness of intraoperative i-PTH measurement in improving surgical success, particularly in cases with inconclusive preoperative imaging results.
Between January 2010 and September 2020, 203 adult patients who underwent surgery for PHPT in our clinic were included in the study. Patients were categorized into two groups: Group A (with intraoperative i-PTH measurement) and Group B (without i-PTH measurement). Persistent hyperparathyroidism was defined as elevated calcium levels occurring shortly after surgery, whereas recurrence was defined as calcium elevation after the 6th postoperative month. The absence of recurrence or persistent hypercalcemia was considered an indicator of surgical success.
The mean age of the patients was 54.6 ± 12.7 years. Of the 203 patients, 40 (19.7%) were male and 163 (80.3%) were female. No correlation was found between recurrence or persistence and patient age. The overall success rate was 93.6%. Surgical success was achieved in 97.8% of patients in Group A and 90% in Group B, indicating a statistically significant difference between the groups (p = 0.023).
Intraoperative i-PTH measurement significantly increases the success rate of PHPT surgery, reducing the incidence of recurrent or persistent cases and the need for secondary operations. Consequently, it helps prevent complications associated with reoperations. These findings highlight the pivotal role of intraoperative i-PTH monitoring in optimizing surgical outcomes, especially in complex PHPT cases.
原发性甲状旁腺功能亢进症（PHPT）是由一个或多个甲状旁腺分泌过多甲状旁腺激素引起的。PHPT的主要治疗方法是手术。由于甲状旁腺的解剖变异，术前定位、手术方式和成功率可能会有所不同。随着先进成像技术的发展以及术中完整甲状旁腺激素（i-PTH）测量的引入，传统的扩大手术方式越来越多地被精准手术所取代。
不同外科医生应用术中i-PTH测量时采用了各种标准。本研究旨在评估术中i-PTH测量在提高手术成功率方面的有效性，尤其是在术前影像学结果不明确的病例中。
2010年1月至2020年9月期间，在我们诊所接受PHPT手术的203例成年患者被纳入研究。患者分为两组：A组（术中测量i-PTH）和B组（未测量i-PTH）。持续性甲状旁腺功能亢进定义为术后不久出现钙水平升高，而复发定义为术后第6个月后钙水平升高。无复发或持续性高钙血症被视为手术成功的指标。
患者的平均年龄为54.6±12.7岁。在203例患者中，40例（19.7%）为男性，163例（80.3%）为女性。未发现复发或持续性与患者年龄之间存在相关性。总体成功率为93.6%。A组97.8%的患者手术成功，B组为90%，两组之间存在统计学显著差异（p = 0.023）。
术中i-PTH测量显著提高了PHPT手术的成功率，降低了复发或持续性病例的发生率以及二次手术的需求。因此，它有助于预防与再次手术相关的并发症。这些发现凸显了术中i-PTH监测在优化手术结果中的关键作用，尤其是在复杂的PHPT病例中。
