Molinari A S, Irvin G L, Deriso G T, Bott L
Department of Surgery, University of Miami School of Medicine, FL 33101, USA.
Surgery. 1996 Dec;120(6):934-6; discussion 936-7. doi: 10.1016/s0039-6060(96)80036-5.
Successful parathyroidectomy depends on recognition and excision of all hyperfunctioning parathyroid glands. Because histologic definition is limited, multiglandular disease (MGD) is usually determined grossly by means of estimation of gland size and the experience of the surgeon, resulting in frequency varying from 8% to 33%. Normalization of elevated intraoperative intact parathyroid hormone (iPTH) levels after excision of all hyperfunctioning glands is necessary for postoperative normocalcemia and indicates normal secretion of remaining parathyroids. Abnormal hormone secretion measured during operation has been used to define the extent of excision and the incidence of MGD.
One hundred ten consecutive parathyroidectomy patients with no previous neck surgery or history of multiple endocrine neoplasia had intraoperative iPTH assays performed before and after excision of any suspected abnormal parathyroid gland(s). A drop in iPTH level after gland excision predicted postoperative normal calcium levels.
All patients except one had normalization of serum calcium levels (average follow-up, 15 months). One hundred five patients had only one hyperfunctioning gland removed, and all have remained normocalcemic. Five (5%) patients had more than one gland involved: four had two or more hyperfunctioning parathyroids and one patient, who had a large parathyroid cyst removed, remained hypercalcemic.
By using a biochemical assay, instead of estimated size, to predict which parathyroid glands are hypersecreting, the incidence of MGD in primary hyperparathyroidism was found to be 5%.
成功的甲状旁腺切除术取决于识别并切除所有功能亢进的甲状旁腺。由于组织学定义有限，多腺体疾病（MGD）通常通过腺体大小估计和外科医生的经验进行大体判断，其发生率在8%至33%之间。切除所有功能亢进的腺体后，术中完整甲状旁腺激素（iPTH）水平升高恢复正常对于术后血钙正常至关重要，且表明剩余甲状旁腺分泌正常。术中测量的异常激素分泌已被用于确定切除范围和MGD的发生率。
110例连续接受甲状旁腺切除术的患者，既往无颈部手术史或多发性内分泌腺瘤病史，在切除任何可疑异常甲状旁腺前后进行术中iPTH检测。腺体切除后iPTH水平下降预示术后血钙水平正常。
除1例患者外，所有患者血钙水平均恢复正常（平均随访15个月）。105例患者仅切除了一个功能亢进的腺体，所有患者血钙均保持正常。5例（5%）患者有不止一个腺体受累：4例有两个或更多功能亢进的甲状旁腺，1例患者因切除了一个大的甲状旁腺囊肿仍有高钙血症。
通过使用生化检测而非估计大小来预测哪些甲状旁腺分泌过多，发现原发性甲状旁腺功能亢进中MGD的发生率为5%。
