Boggs J E, Irvin G L, Molinari A S, Deriso G T
Department of Surgery, University of Miami School of Medicine, Jackson Memorial and Veterans Affairs Medical Centers, FL 33101, USA.
Surgery. 1996 Dec;120(6):954-8. doi: 10.1016/s0039-6060(96)80040-7.
Parathyroidectomy has a success rate of greater than 95% in the hands of experienced surgeons. To maintain this result in a more cost-effective way, intraoperative monitoring of intact parathyroid hormone (iPTH) has been used to decrease operative times. This technique signals when all hyperfunctioning tissue has been excised or when further dissection is necessary.
Eighty-nine consecutive patients with hyperparathyroidism had plasma samples measured for iPTH levels during parathyroidectomy. Nine patients had previous neck explorations. Perioperative iPTH measurements using immunochemiluminescent assays with a turnaround time of 10 minutes were done after excision of each suspected abnormal parathyroid gland.
All patients except one returned to and maintained normal calcium levels during the follow-up period of 8 months (range, 1 to 25 months). Prediction of postoperative calcium levels by means of quick immunochemiluminescent assay has a sensitivity of 97%, specificity of 100%, and an overall accuracy of 97%. Specific influence on surgical judgment was noted in four patients with multiglandular disease, in seven with difficult localization problems, and in one patient in whom the hyperfunctioning parathyroid tissue was not recognized. Monitoring the plasma iPTH levels during parathyroidectomy directly aided the surgeon's operative approach in these 12 patients.
Intraoperative iPTH assay is useful with predictive accuracy of 97%. It influenced or changed the operative approach in 13% of patients.
在经验丰富的外科医生手中，甲状旁腺切除术的成功率超过95%。为了以更具成本效益的方式维持这一结果，术中对完整甲状旁腺激素（iPTH）进行监测已被用于缩短手术时间。该技术可在所有功能亢进组织被切除或需要进一步解剖时发出信号。
89例连续性甲状旁腺功能亢进患者在甲状旁腺切除术中检测血浆iPTH水平。9例患者曾接受过颈部探查。在切除每个疑似异常甲状旁腺后，采用免疫化学发光法进行围手术期iPTH测量，周转时间为10分钟。
除1例患者外，所有患者在8个月（范围1至25个月）的随访期内恢复并维持了正常血钙水平。通过快速免疫化学发光法预测术后血钙水平的敏感性为97%，特异性为100%，总体准确率为97%。在4例多腺体疾病患者、7例定位困难患者以及1例未识别出功能亢进甲状旁腺组织的患者中，观察到对手术判断有特定影响。在这12例患者中，甲状旁腺切除术中监测血浆iPTH水平直接有助于外科医生的手术操作。
术中iPTH检测很有用，预测准确率为97%。它在13%的患者中影响或改变了手术方式。
