原发性甲状旁腺机能亢进患者术中监测甲状旁腺激素的临床意义

目的：探讨原发性甲状旁腺机能亢进症（PHPT）患者术中动态监测甲状旁腺激素（IOPTH）的临床价值。方法：回顾性分析1998年1月—2012年1月行手术治疗的36例PHPT患者的临床资料，其中2005年以后术中行IOPTH监测患者22例（IOPTH组），2005年以前术中未行IOPTH监测的患者14例（常规组），比较两组的术中情况与治疗效果。结果：与常规组比较，IOPTH组手术时间明显缩短[（72.95±24.34）min vs.（81.86±29.46）min，P=0.000]，术后短期（1个月内）甲状旁腺功能恢复患者比例增加（90.9% vs. 57.1%，P=0.018），永久性甲状旁腺功能减退发生率明显减少（4.5% vs. 28.6%，P=0.042）。IOPTH监测对于判断高功能病灶完全切除与否的敏感度为100%，准确率为95.5%。结论：PHPT手术中，在术前定位基础上联合IOPTH，有助于判断功能亢进腺体是否全部切除，避免遗漏多发病变腺体及不必要的双侧探查，缩短手术时间，疗效确切。

Clinical significance of intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism during parathyroidectemy

Objective: To assess the clinical value of intraoperative parathyroid hormone (IOPTH) monitoring for patients with primary hyperparathyroidism (PHPT) during parathyroidectomy. Methods: The clinical data of 36 PHPT patients undergoing surgical treatment from January 1998 to January 2012 were retrospectively analyzed. Of the patients, 22 cases (before 2005) received IOPTH monitoring (IOPTH group) during surgery and 14 cases (after 2005) underwent parathyroidectomy without IOPTH monitoring (conventional group). The intraoperative conditions and therapeutic efficacies between the two groups were compared.Results: Compared with conventional group, in IOPTH group, the operative time was reduced [(72.95±24.34) min vs. (81.86±29.46) min, P=0.000], ratio of patients with short-term (within the first month after surgery) recovery of parathyroid function increased (90.9% vs. 57.1%, P=0.018), and incidence of permanent hypoparathyroidism decreased (4.5% vs. 28.6%, P=0.042). The sensitivity and accuracy of IOPTH monitoring for judgment of whether or not the hyperfunctioning lesions were completely resected was 100% and 95.5%, respectively.Conclusion: On the basis of preoperative localization, using IOPTH monitoring during parathyroidectomy is helpful to determine whether the hyperfunctioning glands are completely removed, and to avoid missing a synchronous lesion and unnecessary bilateral exploration. In addition, it reduces the operation time and is of precise efficacy.