Pearl A J, Chapnik J S, Freeman J L, Bain J, Salem S, Kirsh J, Noyek A M
Department of Otolaryngology, McGill University, Montreal, Quebec, Canada.
J Otolaryngol. 1993 Aug;22(4):301-6.
The successful diagnosis and surgical treatment of primary hyperparathyroidism due to parathyroid adenoma benefits significantly, in our experience, from a process of pre-operative imaging localization of the parathyroid adenoma. This prospective study evaluates a window of 25 consecutive patients who underwent pre-operative imaging localization prior to successful unilateral parathyroidectomy for parathyroid adenoma. All parathyroid adenomas were successfully localized by imaging, and subsequently documented photographically in surgical correlation, and pathologically confirmed. All patients were cured biochemically. Ultrasound accurately localized 92% of adenomas (100% in the neck and extrathyroidal) while radionuclide subtraction scanning identified 60% of a smaller subset. Both DSA and CT were successful in the two cases utilized, and MRI demonstrated four of five adenomas. The high yield of these pre-operative localization studies should make them an important consideration in the routine evaluation of patients undergoing surgery for possible parathyroid adenoma. Their usefulness in directing a conservative unilateral operation may result in time and cost savings, as well as reduced surgical exposure.
根据我们的经验，对于因甲状旁腺腺瘤导致的原发性甲状旁腺功能亢进症，成功的诊断和外科治疗在很大程度上得益于甲状旁腺腺瘤术前影像定位这一过程。这项前瞻性研究评估了连续25例患者，这些患者在成功进行单侧甲状旁腺腺瘤甲状旁腺切除术前均接受了术前影像定位。所有甲状旁腺腺瘤均通过影像成功定位，随后在手术对照中进行了摄影记录，并经病理证实。所有患者均生化治愈。超声准确地定位了92%的腺瘤（颈部及甲状腺外腺瘤的定位准确率为100%），而放射性核素减影扫描识别出了较小亚组中的60%。在使用的两例病例中，数字减影血管造影（DSA）和计算机断层扫描（CT）均成功，磁共振成像（MRI）显示了五例腺瘤中的四例。这些术前定位研究的高成功率应使其成为对可能患有甲状旁腺腺瘤而接受手术的患者进行常规评估时的重要考虑因素。它们在指导保守性单侧手术方面的作用可能会节省时间和成本，同时减少手术暴露。
