核素介导继发性甲状腺旁腺功能亢进的外科治疗

目的：探索γ射线探测仪在继发性甲状旁腺功能亢进症外科治疗中的价值。方法：我们回顾性分析2007年5月到2011年9月 在我院接受术、切除甲状旁腺；组II共１３例患者在γ射线探测仪引导下完成全继发性甲状旁腺功能亢进症外科治疗的48例患者的临床资料。所有的患者术前均经超声及99Tc-MIBI显像定位甲 状旁腺。组I共35例患者采用传统的颈部探查手甲状旁腺切除术、部分甲状旁腺种植术。我们比较二组切除甲状旁腺的数目、手术时间、术后PTH、Ca 、P 血浆水平的变化。结果：这二组之间临床特征、PTH及Ca 水平、年龄分布均无差异。术前99Tcm-MIBI 显像诊断准确率（89.74%）与超声诊断准确率（81.25%）无显著差异。但是99Tcm-MIBI 显像定位准确率（66.67%）显著低于超声定位准确率（76.86%）。手术时间第一组（120 ± 25 min ）显著长于第二组(90 ± 30 min)。术中查找甲状旁腺的准确率第二组(92.59%)显著高于第一组(80.39%)。第一组切除的甲状旁腺的数量(2.5 ± 0.5)显著低于第二组(3.5 ± 0.5)第二组较第一组多切除15.4%的甲状旁腺。所有患者术后PTH、Ca 、P 水平较术前均明显下降。结论：术中γ射线探测仪能证实所切除的组织为甲状旁腺提高了甲状旁腺切除的准确性。鉴于γ射线探测仪的应用提高了甲状旁腺切除率15.4%。然而γ射线探测仪不能发现所有甲状旁腺增生病灶，至于原因有待于我们进一步的深入研究。

Radioguided parathyroidectomy for secondary hyperparathyroidismFei Yuan*, Weijia Yu*, Waqas Ahmad, Zhixue Yang, Hua Cao, Juncheng Li, Guoqin Jiang*

Background: The value of gamma probes in the surgical treatment of secondary hyperparathyroidism (sHPT) was determined. Methods: We retrospectively analyzed the clinical data of 48 sHPT patients between May 2007 and September 2011. Preoperative 99Tcm-methoxyisobutyl isonitrile (MIBI) scintigraphy and high-frequency ultrasonography were used for parathyroid localization. Thirty-five patients (group I) underwent conventional neck exploration and open parathyroidectomy. Thirteen patients (group II) underwent gamma probe-guided total parathyroidectomy and parathyroid transplantation. The two groups were compared in terms of the number of parathyroid resections, operative time and postoperative changes in the blood levels of parathyroid hormone (PTH), calcium and phosphate. Results: The clinical manifestations, PTH and calcium levels, age distribution and clinical characteristics did not differ between the two groups. The accuracy of preoperative 99Tcm-MIBI scintigraphy (89.74%) for the diagnosis of hyperparathyroidism did not differ from that of ultrasonography (81.25%). However, the accuracy of 99Tcm-MIBI scintigraphy (66.67%) for localizing hyperfunctioning parathyroids was significantly lower than that of ultrasonography (76.86%). The operation time was significantly longer in group I (120 ± 25 min) than in group II (90 ± 30 min). The accuracy of parathyroid identification was significantly higher in group II (92.59%) than in group I (80.39%). On average, significantly fewer parathyroid specimens were obtained in group I (2.5 ± 0.5) than in group II (3.5 ± 0.5). Compared with group I, group II showed a significant increase (15.4%) in the number of parathyroid resections. The PTH, calcium and phosphate levels significantly decreased postoperatively in all patients. Conclusion: Intraoperative gamma probe examination confirmed that the excised specimen was parathyroid tissue and improved the accuracy of parathyroid resection. The parathyroidectomy rate was increased by 15.4% due to the use of these probes. However, the probes did not detect all ectopic parathyroids, and further research is required to clarify the underlying reasons.