Chapuis Y, Fulla Y, Bonnichon P, Tarla E, Abboud B, Pitre J, Richard B
Department of Surgery, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France.
World J Surg. 1996 Sep;20(7):835-9; discussion 839-40. doi: 10.1007/s002689900127.
Unilateral neck exploration (UNE) is a controversial approach to the treatment of primary hyperparathyroidism (PHP), and most surgeons favor bilateral neck exploration. The aim of this study was to assess the value of ultrasonography, sestamibi scintigraphy, and intraoperative measurement of urinary cyclic AMP (UcAMP) or 1-84 PTH in 200 patients undergoing unilateral neck exploration under local anesthesia. Conditions for UNE were (1) a presumed solitary adenoma detected by ultrasonography, (2) no thyroid disease, and (3) no family history of PHP or multiple endocrine neoplasia. Patient's consent was obtained for conversion to bilateral exploration according to surgical and biologic findings. Sensitivity of ultrasonography was 92.5%. Sestamibi scintigraphy, performed in 70 patients, was less sensitive than ultrasonography (80%). Persistent PHP was accurately detected by intraoperative measurement of UcAMP or 1-84 PTH in all cases. At follow-up, 96.0% of the patients were cured either after unilateral neck exploration only (90.5%), or after conversion into bilateral exploration. Ultrasonography and intraoperative measurement of 1-84 PTH allow unilateral neck exploration with excellent results in a selected group of patients with PHP.
单侧颈部探查（UNE）是一种治疗原发性甲状旁腺功能亢进症（PHP）存在争议的方法，大多数外科医生倾向于双侧颈部探查。本研究的目的是评估超声检查、锝[99mTc]甲氧基异丁基异腈闪烁扫描（sestamibi闪烁扫描）以及术中测定尿环磷酸腺苷（UcAMP）或1-84甲状旁腺激素（PTH）在200例接受局部麻醉下单侧颈部探查患者中的价值。UNE的条件为：（1）超声检查发现疑似孤立性腺瘤；（2）无甲状腺疾病；（3）无PHP或多发性内分泌腺瘤病家族史。根据手术和生物学检查结果，征得患者同意后可转为双侧探查。超声检查的敏感性为92.5%。70例患者进行了sestamibi闪烁扫描，其敏感性低于超声检查（80%）。在所有病例中，通过术中测定UcAMP或1-84 PTH可准确检测到持续性PHP。随访时，96.0%的患者在仅进行单侧颈部探查后（90.5%）或转为双侧探查后治愈。超声检查和术中测定1-84 PTH可使选定的一组PHP患者进行单侧颈部探查并取得良好效果。
