PTH监测在原发性甲旁亢手术中的应用  

Intraoperative parathyroid hormone examination in parathyroidectomy for primary hyperparathyroidism

作　　者：王培松[1] 韩祎[1] 王硕[1] 金美善[2] 薛帅[1] 刘嘉[1] 孟伟[1] 孟宪瑛[1] 王贵民[1] 韩哲[1] 陈光[1] 

机构地区：[1]吉林大学第一医院甲状腺外科,长春130021 [2]吉林大学第一医院病理科,长春130021

出　　处：《中华内分泌外科杂志》2017年第1期20-23,44,共5页Chinese Journal of Endocrine Surgery

基　　金：吉林省卫生厅课题（20102100）

摘　　要：目的探讨术中甲状旁腺素（intraoperative parathyroid hormone，IOPTH）监测在原发性甲状旁腺功能亢进（primary hyperparathyroidism，PHPT）患者行甲状旁腺肿物切除术中的作用及效果。方法回顾分析2009年01月至2014年12月吉林大学第一医院甲状腺外科因PHPT行手术治疗且术中行PTH监测的41例临床资料，总结其临床表现、检查手段及手术方式，观察手术前后PTH及血钙的变化。结果41例中男12例，女29例。甲状旁腺腺瘤36例，甲状旁腺癌5例。甲状旁腺腺瘤核素99Tcm-MIBI检查24例，定位23例，甲状旁腺癌3例核素99Tcm-MIBI检查，定位2例（P=0.213）。肿瘤切除后10 min，腺瘤组PTH均下降至肿瘤切除前50%以下。旁腺癌组5例中4例下降至50%以下，1例未明显下降。36例甲状旁腺腺瘤中23例术后出现明显低钙表现，5例甲状旁腺癌患者中2例出现低钙（P=0.361）。术后均无声音嘶哑、饮水呛咳、出血发生。术后随访6~72个月，低钙症状于术后2周至3个月恢复。无永久性甲旁减。1例甲状旁腺癌于术后5个月死于高钙血症，其余40例无复发及死亡病例。结论术中PTH监测有助于医生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，手术治疗效果满意，准确性高，建议在PHPT手术中常规应用。ObjectiveTo explore the effect of intraoperative parathyroid hormone （IOPTH） examination on parathyroidectomy for primary hyperparathyroidism.MethodsThe clinical data of 41 PHPT patients who received IOPTH monitoring （IOPTH group） from Jan. 2009 to Dec. 2014 were retrospectively analyzed. The clinical manifestation, examination and changes of parathyroid hormone and calcium before and after operation were collected.ResultsThere were 12 males and 29 females. 36 cases had parathyroid adenoma, and 5 cases were parathyroid carcinoma. 23 cases were positive in 24 cases of 99Tcm-MIBI parathyroid adenoma radionuclide examination, and 2 cases were positive in 3 cases of parathyroid carcinoma radionuclide 99Tcm-MIBI inspection （P=0.213） . 10 mins after tumor resection, PTH in all cases decreased by 50% or more than that before tumor resection except for one case of parathyroid carcinoma. 23 cases appeared hypocalcemia in 36 cases of parathyroid adenoma after surgery and 2 cases appeared hypocalcemia in 5 cases of parathyroid cancer patients （P=0.361） . No postoperative hoarseness, cough, bleeding occoured. Patients were followed up from 6 to 72 months. Hypocalcemia symptoms recovered 2 weeks to 3 months after surgery. No permanent hypoparathyroidism occured. One case of parathyroid carcinoma died of hypercalcemia 5 months after surgery. The remaining 40 cases survived without recurrence or death.ConclusionsIntraoperative PTH monitoring can help doctors analyze whether all the hyperthyroidism glands have been removed, which can help to avoid miss diagnosis of multiple gland disease and unnecessary bilateral neck exploration. This method is highly accurate so it is recommended for routine use in PHPT surgery.

关 键 词：原发性甲状旁腺功能亢进 甲状旁腺腺瘤 甲状旁腺癌 外科治疗 甲状旁腺素 

分 类 号：R653[医药卫生—外科学]