Roe S M, Burns R P, Graham L D, Brock W B, Russell W L
Department of Surgery, Chattanooga Unit, University of Tennessee College of Medicine.
Ann Surg. 1994 May;219(5):582-6.
To evaluate the effect of preoperative localization studies on the surgical management of patients with primary hyperparathyroid disease (PHPT).
Reported cure rates of initial surgical exploration for PHPT are close to 95%. Preoperative localization studies are frequently obtained to improve surgical success and decrease operative time.
Initial cervical exploration was performed in 113 patients with PHPT from 1981 to 1993. Twenty-four patients (21%) had surgery without preoperative localization studies. The remaining 89 patients (79%) had 132 noninvasive preoperative localization studies. Success of the localization studies in tumor localization, pathologic findings, postoperative serum calcium levels, and operative times were compared. Patient costs of the studies were calculated.
Disease was identified during operation in 23 of 24 patients (96%) having cervical exploration without preoperative localization studies, and they had normal calcium levels after surgery. Eighty-seven of 89 patients (98%) having preoperative localization studies were surgically cured. The highest sensitivity rate (60%) and highest positive predictive value (79%) of the localization studies were found with thallium-technetium scintiscanning. Average cost of the localization studies was $901 per patient. Combination studies were obtained in 32 patients at an average cost of $1,314 per patient without improving sensitivity. Mean operating time did not differ for localized and nonlocalized patients.
Preoperative localization studies did not improve parathyroid localization or cure rate and did not substantially shorten operating time in initial cervical exploration for PHPT. The economic burden of routine preoperative localization studies in these patients is not justified.
评估术前定位检查对原发性甲状旁腺功能亢进症（PHPT）患者手术治疗的影响。
报道的PHPT初次手术探查治愈率接近95%。经常进行术前定位检查以提高手术成功率并缩短手术时间。
1981年至1993年对113例PHPT患者进行了初次颈部探查。24例患者（21%）未进行术前定位检查即接受手术。其余89例患者（79%）进行了132项非侵入性术前定位检查。比较定位检查在肿瘤定位、病理结果、术后血清钙水平和手术时间方面的成功率。计算了这些检查的患者费用。
24例未进行术前定位检查而接受颈部探查的患者中，23例（96%）在手术中确诊疾病，术后血钙水平正常。89例进行术前定位检查的患者中，87例（98%）手术治愈。铊-锝闪烁扫描的定位检查灵敏度最高（60%），阳性预测值最高（79%）。定位检查的平均费用为每位患者901美元。32例患者进行了联合检查，每位患者平均费用为1314美元，但未提高灵敏度。定位和未定位患者的平均手术时间无差异。
术前定位检查并未改善甲状旁腺的定位或治愈率，也未显著缩短PHPT初次颈部探查的手术时间。对这些患者进行常规术前定位检查的经济负担不合理。
