Patel P C, Pellitteri P K, Patel N M, Fleetwood M K
Departments of Otolaryngology-Head and Neck Surgery, Penn State Geisinger Health System, Danville 17822-1333, USA.
Arch Otolaryngol Head Neck Surg. 1998 May;124(5):559-62. doi: 10.1001/archotol.124.5.559.
To evaluate the utility of a rapid intraoperative parathyroid hormone (PTH) immunoradiometric assay in the surgical management of parathyroid disease, particularly with reference to limiting extent of cervical exploration.
Nonrandomized prospective study.
Academic tertiary care center.
Forty-three consecutive patients undergoing parathyroid exploration for adenoma or hyperplasia had rapid PTH assays performed from blood drawn at induction and 7 minutes after resection of all hyperfunctioning parathyroid tissue.
Excision of all hyperfunctioning parathyroid tissue as assessed by bilateral neck exploration, postoperative normalization of serum calcium and PTH levels, and resolution of clinical symptoms.
The intraoperative rapid PTH assay accurately reflected whether all hyperfunctioning parathyroid tissue was excised in every patient. In 41 patients, all hyperfunctioning parathyroid tissue was resected at the time of surgery and confirmed by a corresponding decrease in the intraoperative postexcision rapid PTH determination as well as by subsequent normalization of postoperative serum calcium and PTH levels and resolution of clinical symptoms. In 2 patients, the postexcision rapid PTH assay determination was not consistent with removal of all hyperfunctioning parathyroid disease and both patients demonstrated persistent hyperparathyroidism postoperatively.
The intraoperative rapid PTH assay may be of significant benefit in permitting directed unilateral parathyroid explorations for adenoma when combined with preoperative localization with a technetium-99m sestamibi scan. Additionally, the rapid PTH assay has proved to be of benefit in confirming excision of all hyperfunctioning parathyroid tissue in patients with multiple gland hyperplasia, particularly those who may harbor ectopic parathyroid tissue.
评估术中快速甲状旁腺激素（PTH）免疫放射测定法在甲状旁腺疾病外科治疗中的效用，尤其是在限制颈部探查范围方面的作用。
非随机前瞻性研究。
学术性三级医疗中心。
43例因腺瘤或增生接受甲状旁腺探查的连续患者，在诱导时及切除所有功能亢进的甲状旁腺组织7分钟后采集血液进行快速PTH测定。
通过双侧颈部探查评估所有功能亢进的甲状旁腺组织是否被切除、血清钙和PTH水平术后是否恢复正常以及临床症状是否缓解。
术中快速PTH测定准确反映了每位患者所有功能亢进的甲状旁腺组织是否被切除。41例患者在手术时切除了所有功能亢进的甲状旁腺组织，术中切除后快速PTH测定相应降低，术后血清钙和PTH水平恢复正常以及临床症状缓解均证实了这一点。2例患者切除后快速PTH测定结果与所有功能亢进的甲状旁腺疾病被切除的情况不一致，这2例患者术后均表现为持续性甲状旁腺功能亢进。
术中快速PTH测定与术前99m锝甲氧基异丁基异腈扫描定位相结合，在对腺瘤进行有针对性的单侧甲状旁腺探查时可能具有显著益处。此外，快速PTH测定已被证明有助于确认多腺体增生患者所有功能亢进的甲状旁腺组织是否被切除，尤其是那些可能存在异位甲状旁腺组织的患者。
