99TCm-甲氧基异丁基异腈在甲状旁腺切除术中定位诊断的效果评价  

Effect of 99Tcm-MIBI in intraoperative localization during parathyroidectomy

作　　者：李平[1,2] 徐道亮 刘昌华[2] Li Ping;Xu Daoliang;Liu Changhua(Dalian Medical University, Dalian 116044, China;Department of Nephrology, Jiangsu Subei People's Hospital, Yangzhou 225009, China)

机构地区：[1]大连医科大学,辽宁大连116044 [2]江苏省苏北人民医院肾内科,江苏扬州225009

出　　处：《中华临床医师杂志（电子版）》2019年第6期429-434,共6页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的 评价99TCm-甲氧基异丁基异腈(99TCm-MIBI)在继发性甲状旁腺功能亢进症患者甲状旁腺切除手术中定位诊断的效果。方法 回顾性分析2012 年2 月至2018 年9 月在江苏省苏北人民医院肾内科行手术治疗的33 例继发性甲状旁腺功能亢进症患者的临床资料。根据手术方法不同分为2 组,术中接受99TCm-MIBI 引导的甲状旁腺切除术者为Ⅰ组,术中未接受99TCm-MIBI 引导者为Ⅱ组。分别统计2 组手术时间、手术并发症等情况,并以手术前后生化指标变化、病理检查等为依据,分别计算手术缓解率、成功率、复发率及病理阳性率。采用t 检验比较手术时间、手术前后血钙、血磷及术前血甲状旁腺激素(PTH)的组间和组内差异,采用非参数检验比较术后血PTH 的组间和组内手术前后的差异,采用Fisher 确切概率法比较手术成功率、缓解率、术后短期复发率及病理阳性率的组间差异。结果 2 组的手术时间及并发症的情况比较,差异无统计学意义(P > 0.05)。2 组患者术后第1 天、1 周、6 个月的血钙、血磷、PTH 均较术前降低,差异有统计学意义(P 均< 0.05)。Ⅰ组、Ⅱ组手术缓解率(100% vs 86.7%)及术后短期复发率(0% vs 7.7%)比较,差异均无统计学意义(P > 0.05)。手术成功率(100% vs 73.3%)及病理阳性率(100% vs 92.7%)比较,差异均具有统计学意义(P=0.033,P=0.033)。结论 99TCm-MIBI 是一种有效可行的术中定位手段,采用99TCm-MIBI 引导下的甲状旁腺切除术治疗继发性甲状旁腺功能亢进,能达到更高的病理阳性率,提高手术成功率。同时,因99TCm-MIBI 更精确的定位,理论上或可降低术后短期复发率及术后并发症的发生率,替代术中病理,以缩短手术时间。Objective To evaluate the effect of 99Tcm-methoxyisobutylisonitrile (99Tcm-MIBI) in intraoperative localization during parathyroidectomy for secondary hyperparathyroidism patients. Methods Clinical data of 33 patients who underwent parathyroidectomy for secondary hyperparathyroidism at the Department of Nephrology, Jiangsu Subei People's Hospital from February 2012 to September 2018 were reviewed retrospectively. Patients were divided into two groups according to operative method, namely, patients undergoing parathyroidectomy with 99Tcm-MIBI guidance (group Ⅰ) and those undergoing parathyroidectomy without 99Tcm-MIBI guidance (group Ⅱ). Operative time and complications were collected, and the remission rate, successful rate, recurrence rate, and pathological positive rate were calculated by biochemical indexes and pathological results. The t-test was used to compare the intra- and inter-group differences of operative time, blood calcium and phosphorus, and preoperative blood parathyroid hormone (PTH), non-parametric tests were used to compare the intra-and inter-group differences of postoperative blood PTH, and the Fisher's exact probability method was used to compare the differences of success, remission, short-term recurrence, and pathological positive rates. Results There was no significant difference in operation time or complications between the two groups (P > 0.05). The levels of serum calcium, phosphorus, and PTH in the two groups on the 1st day, 1st week, and 6th month after operation were significantly lower than those before operation (P < 0.05). There was no significant difference in remission rate (100% vs 86.7%) or short-term recurrence rate (0% vs 7.69%) between groups Ⅰ and Ⅱ(P > 0.05), although the successful rate of operation (100% vs 73.3%) and pathological positive rate (100% vs 92.7%) were significantly different between the two groups (P=0.033, P=0.033). Conclusions Compared with parathyroidectomy without 99Tcm-MIBI guidance, intraoperative 99Tcm-MIBI radio-guided parathyroidectomy f

关 键 词：继发性甲状旁腺功能亢进症 甲状旁腺切除术 甲状旁腺激素 99TCm-甲氧基异丁基异腈 

分 类 号：R653[医药卫生—外科学]