甲状旁腺激素测定在继发性甲状旁腺功能亢进手术中的临床应用

目的 探讨甲状旁腺激素测定在继发性甲状旁腺功能亢进手术中的应用和标准.方法 17例继发性甲状旁腺功能亢进患者行甲状旁腺次全切除术,分别测定麻醉后切开皮肤前PTH值(PTH0)及最后1个旁腺次全切除后10 min的PrrH值(PTH10).预测手术成功标准:(1)最后旁腺切除后10 min PTH10下降至≤150 pg/mL,(2)最后旁腺切除后10 rain PTH10与PTH0直接比≤30%.结果 15例符合预测成功标准,术后第7天,PTH＜15 pg/mL者4例,PrrH在15～65 pg/mL者6例,PTTH在65-185.2 pg/mL 5例.术后骨痛症状均消失.结论 术中甲状旁腺激素测定有助于继发性甲状旁腺功能亢进的旁腺切除,能极大提高手术成功率.

Clinical application of intraoperative parathyroid hormone assay during parathyroidectomy for secondary hyperparathyroidism

Objective:To investigate the application and criteria of intraoperative parathyroid hormone assay during surgery of secondary hyperparathyroidism. Methods :Subtotal parathyroidectomy was performed in 17 cases of secondary hyperparathyroidism. Parathyroid hormone assay was performed after induction of anaesthesia but before incision(PTH0) and 10min(PTH10) after subtotal parathyroidectomy. Two successive criteria of PTH decrease were used: (1) PTH10 of ≤150pg/mL; (2) PTH10 /PTH0≤30%. Results:Fifteen cases met the criteria. There were PTH<15 pg/m in 4 cases, PTH of 15-65 pg/mL in 6 cases, and PTH of 65-185.2 pg/mL in 5 cases day 7 postoperatively. Bone pain resolved in all cases after operation. Conclusions:Intraoperative parathyroid hormone assay can help for hyperparathyroid gland resection in secondary hyperparathyroidism, and can improve the successful rate of operation