术中甲状旁腺激素测定评判继发性甲状旁腺功能亢进手术成功的标准构想

目的 探讨继发性甲状旁腺功能亢进(SHPT)在甲状旁腺近全切术和甲状旁腺全切术应用术中甲状旁腺激素(IOPTH)测定方法预测手术成功标准。 方法 105例SHPT患者行甲状旁腺近全切或全切除术,分别于麻醉后切开皮肤前测PTH值(PTH₀)及最后一个甲状旁腺近全切或全切除后10 min测PTH值(PTH₁₀)。预测手术成功标准:(1) PTH₁₀值下降至≤150 pg/mL;(2) PTH₁₀/PTH₀≤30%。 结果 96例达标符合手术成功标准,PTH下降在达标与未达标者间差异有统计学意义,且血钙下降明显。设定术后PTH正常和低下为治愈标准,则假阳性率为9.38%,复发率为23.33%。如按K/DOQI指南设定PTH<300 pg/mL为治愈标准,则复发率为5%。随访6个月后,真阳性的血钙、磷下降与术前比较差异有统计学意义,而未达标者差异无统计学意义。 结论 在SHPT行甲状旁腺近全切或全切除术,PTH₁₀/PTH₀≤30%可预测手术成功和治愈。

Conception of successive criterion of intraoperative parathyroid hormone assay during parathyroidectomy in secondary hyperparathyroidism

Objective Evaluation of intraoperative parathyroid hormone(IOPTH)measurement for predicting successful surgery in patients undergoing near or total parathyroidectomy due to secondary hyperparathyroidism(SHPT). Methods The near or total parathyroidectomy were performed in 105 cases of SHPT. Parathyroid hormone assay were measured in operation after induction of anaesthesia but before incision(PTH₀)and 10 min(PTH₁₀)after last parathyroid was excised. The success criteria of indicating surgery in near or total parathyroidectomy were used as follow: (1) PTH₁₀≤150 pg/m, (2) a relative of PTH₁₀/PTH₀≤30%. Results 96 cases of successful operation met the criteria. Comparing to unsuccessful criteria, the decline of PTH had significant difference. Decline of calcium levels of these patients was evident after the surgery. The causing false positive rates and recurrence rates was 9.38% and 23.33% separately when it set normal PTH or low PTH as the curing criterion after 6 months follow-up. And the recurrence rates was 5% if It was PTH<300 pg/mL in the curing criterion according to K/DOQI guidelines. Decline of calcium and phosphorus in true positive cases compare to pre-operation had significant difference but it was not change in no successive criterion cases. Conclusion PTH₁₀/PTH₀≤30% was appropriate to predicte success of near or total parathyroidectomy for patients with SHPT.