Weber C J, Vansant J, Alazraki N, Christy J, Watts N, Phillips L S, Mansour K, Sewell W, McGarity W C
Department of Surgery, Emory University School of Medicine, Atlanta, Ga. 30322.
Surgery. 1993 Dec;114(6):1011-8.
The purpose of this study was to assess the contribution of technetium 99m sestamibi iodine 123 (T/S) imaging to preoperative and intraoperative management of patients with persistent hyperparathyroidism.
During a period of 10 months, all patients being prepared for reoperative parathyroid surgery (n = 10), two patients deemed significant operative risks (one patient with severe chronic obstructive pulmonary disease and one patient with severe cervical spine ankylosing spondylitis), and two patients who had undergone prior thyroid operation were studied with T/S imaging. Six patients undergoing reoperative surgery had undergone one, three had undergone two, and one had undergone three prior procedures.
T/S imaging correctly localized 14 of 16 parathyroid tumors. By comparison, only 1 of 6 thallium technetium and 3 of 12 computed tomography (CT) scans (in seven patients) were positive. T/S imaging guided the reoperative surgical approach accurately in 12 of 14 patients, including one case of an undescended left lower gland at the level of the mandible and identification of a third gland on the left in another case. Sternal split was required to remove three lesions localized by T/S imaging, two beneath the aortic arch and one nestled in the aortopulmonary window in a patient who had undergone two prior procedures including a sternal split. In these three cases T/S imaging was particularly useful, because CT scans, thallium technetium scans, magnetic resonance imaging, and arteriography were not diagnostic. The outcome after operation was favorable in all 14 cases, with correction of hypercalcemia and no permanent laryngeal nerve injuries or hypocalcemia.
We concluded that T/S imaging is more accurate than thallium technetium and CT scans in evaluation of patients with persistent hyperparathyroidism.
本研究旨在评估锝99m甲氧基异丁基异腈-碘123（T/S）显像对持续性甲状旁腺功能亢进患者术前及术中管理的作用。
在10个月的时间里，对所有准备再次进行甲状旁腺手术的患者（n = 10）、两名被认为手术风险较大的患者（一名患有严重慢性阻塞性肺疾病，一名患有严重颈椎强直性脊柱炎）以及两名曾接受过甲状腺手术的患者进行了T/S显像研究。6例再次手术的患者曾接受过1次手术，3例曾接受过2次手术，1例曾接受过3次手术。
T/S显像正确定位了16个甲状旁腺肿瘤中的14个。相比之下，6例铊-锝扫描中只有1例阳性，12例计算机断层扫描（CT）（7例患者）中只有3例阳性。T/S显像在14例患者中的12例准确指导了再次手术的入路，包括1例下颌骨水平的左下颌下腺未降及另1例左侧发现第3个甲状旁腺。对于T/S显像定位的3个病灶需要行胸骨劈开术切除，2个位于主动脉弓下方，1个位于一名曾接受过包括胸骨劈开术在内的2次手术的患者的主肺动脉窗内。在这3例中，T/S显像特别有用，因为CT扫描、铊-锝扫描、磁共振成像和血管造影均无法明确诊断。所有14例患者术后结果良好，高钙血症得到纠正，无永久性喉返神经损伤或低钙血症。
我们得出结论，在评估持续性甲状旁腺功能亢进患者时，T/S显像比铊-锝扫描和CT扫描更准确。
