术中甲状旁腺素监测在腔镜辅助甲状旁腺切除术中的应用

目的:探讨术中甲状旁腺素监测在腔镜辅助甲状旁腺切除术中的作用及效果。方法:回顾分析2006年10月至2012年12月有完整资料的10例腔镜辅助甲状旁腺切除患者的临床资料,其中男3例,女7例。患者术前血钙2.76～3.82 mmol/L,平均(2.87±0.69)mmol/L。术前甲状旁腺激素(parathyroid hormone,PTH)268.0～1390.8 pg/ml,平均(627.58±156.30)pg/ml。患者均通过B超、核素99mTc-MIBI(99锝m-甲氧基异丁基异腈)和/或CT定位。结果:10例均成功完成手术,无一例中转开放及再次探查手术。术中出血量平均(7.5±3.5)ml,手术时间平均(38.3±12.6)min。腺瘤切除后5 min,PTH平均(306.3±59.38)pg/ml;腺瘤切除后20 min,PTH平均(51.7±13.20)pg/ml,多降至正常。术后石蜡病理证实为甲状旁腺腺瘤,术后均无声嘶、呛咳、出血发生,2例发生短暂性低钙血症,术后随访9例患者2～73个月,美容效果满意,未见复发。结论:临床上内镜辅助甲状旁腺手术安全、可行,术后患者康复快,颈部美容效果好,术中结合甲状旁腺监测可有效保证手术的彻底性,避免盲目探查。

Application of intraoperative parathyroid hormone examination in endoscopic-assisted parathyroidectomy

Objective:To explore the effect of intraoperative parathyroid hormone(iPTH) examination in endoscopic-assisted parathyroidectomy.Methods:The clinical data of 10 patients who underwent endoscopic-assisted parathyroidectomy with comprehensive archives from Oct.2006 to Dec.2012 were reviewed and analyzed,of whom 3 were male and 7 female.Preoperative serum calcium was 2.76-3.82 mmol/L,with an average of(2.87±0.69) mmol/L.The serum parathyroid hormone before surgery was 268.0-1 390.8 pg/ml,the mean was(627.58±156.30) pg/ml.Preoperative localization were achieved by B ultrasound,99mTc-MIBI examination and/or CT scan.Results:All of the 10 operations were accomplished successfully,no conversion to open surgery or reoperation was needed.The mean intraoperative blood loss was(7.5±3.5) ml and the mean operative time was(38.3±12.6) min.The mean PTH was(306.3±59.38) pg/ml 5 min after excision of parathyroid adenoma and was(51.7±13.20) pg/ml 20 min after excision.Parathyroid adenoma was proved by paraffin pathology.No hoarse,bucking or bleeding occurred,and transient hypocalcemia occurred in 2 patients.The cosmetic results were satisfied and no recurrence occurred during the 2-73 months follow-up of 9 patients.Conclusions:Endoscopic-assisted parathyroidectomy is a safe and feasible operation,with advantages of fast recovery and satisfied cosmetic results.The iPTH examination can ensure operative validation,and avoid blind exploration.