Bergenfelz A, Isaksson A, Lindblom P, Westerdahl J, Tibblin S
Department of Surgery, Lund University Hospital, Sweden.
Br J Surg. 1998 Aug;85(8):1129-32. doi: 10.1046/j.1365-2168.1998.00824.x.
The distinction between solitary parathyroid adenoma and hyperplasia can sometimes be difficult during surgery for primary hyperparathyroidism (pHPT), especially in patients who have undergone previous thyroid or parathyroid surgery. The use of intraoperative parathyroid hormone (PTH) monitoring as a possible diagnostic tool was therefore investigated.
Intraoperative levels of PTH were measured in 119 patients during 121 operations (including 14 reoperations) for pHPT. The mean(s.d.) preoperative serum calcium level was 2.79(0.21) mmol/l. Blood samples were drawn before, and at 5 and 15 min after, excision of the first enlarged parathyroid gland. PTH was analysed electively in 61 patients and on-line by a modified assay for intact PTH in 48 patients. Both procedures were used in ten patients.
The mean(s.d.) decline in PTH concentration in 101 patients with primary exploration due to solitary adenoma was 63(17) per cent after 5 min (n=84) and 83(10) per cent after 15 min. The patients with primary exploration because of multiglandular disease (n=6) were correctly predicted not to have parathyroid adenoma.
Measurement of PTH levels during surgery for pHPT is a highly sensitive method for differentiating between single and multiple gland disease. The on-line monitoring of PTH is clinically useful in patients who have undergone previous neck surgery. Its role in pHPT surgery at primary exploration should be evaluated in prospective trials.
在原发性甲状旁腺功能亢进症（pHPT）手术过程中，有时很难区分孤立性甲状旁腺腺瘤和增生，尤其是在既往接受过甲状腺或甲状旁腺手术的患者中。因此，研究了术中甲状旁腺激素（PTH）监测作为一种可能的诊断工具的应用。
在121例pHPT手术（包括14例再次手术）过程中，对119例患者进行了术中PTH水平测定。术前血清钙水平的平均值（标准差）为2.79（0.21）mmol/L。在切除第一个增大的甲状旁腺之前、之后5分钟和15分钟采集血样。对61例患者进行了选择性PTH分析，对48例患者通过改良的完整PTH测定法进行了在线分析。10例患者同时采用了这两种方法。
101例因孤立性腺瘤进行初次探查的患者，PTH浓度在5分钟后平均（标准差）下降63（17）%（n = 84），15分钟后下降83（10）%。因多腺体疾病进行初次探查的患者（n = 6）被正确预测没有甲状旁腺腺瘤。
pHPT手术期间测量PTH水平是区分单腺体和多腺体疾病的高度敏感方法。PTH在线监测对既往接受过颈部手术的患者具有临床实用性。其在初次探查的pHPT手术中的作用应在前瞻性试验中进行评估。
