术中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价值  

Clinical value of intraoperative parathyroid hormone determination in secondary hyperparathyroidism operation

作　　者：陈安举 王田田[1] 薄少军[1] 李洪跃[1] 张聪[1] 杨晓琦[1] 徐先发[1] CHEN Anju;WANG Tiantian;BO Shaojun;LI Hongyue;ZHANG Cong;YANG Xiaoqi;XU Xianfa(Department of Otolaryngology Head and Neck Surgery,Peking University Civil Aviation School of Clinical Medicine,Civil Aviation General Hospital,Beijing,100123,China)

机构地区：[1]北京大学民航临床医学院民航总医院耳鼻咽喉头颈外科

出　　处：《临床耳鼻咽喉头颈外科杂志》2019年第12期1168-1172,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:研究术中甲状旁腺激素测定在继发性甲状旁腺功能亢进(SHPT)患者手术中的临床应用价值。方法:回顾性分析100例首次手术和14例再次手术的SHPT患者资料。预测手术成功标准为最后一枚甲状旁腺切除后20 min时,检测全段甲状旁腺激素(iPTH)较术前下降超过80%。统计分析手术前后iPTH、血钙以及血磷。结果:112例(首次手术98例,再次手术14例)达到手术治愈,手术治愈率为98.2%。109例(首次手术97例,再次手术12例)术中甲状旁腺激素测定达标,预测手术成功的敏感度分别为97.0%和85.7%。术后患者骨关节疼痛、皮肤瘙痒等临床症状明显改善或消失,术后iPTH、血钙以及血磷较术前改变显著,差异有统计学意义(P<0.05)。结论:术中甲状旁腺激素测定对SHPT患者手术有重要的临床指导价值,能够显著提高手术的成功率。最后一枚甲状旁腺切除后20 min时测定iPTH较术前下降超过80%是预测手术成功的良好指标。Objective:To investigate the clinical value of intraoperative parathyroid hormone monitoring in operation of patients with secondary hyperparathyroidism(SHPT).Method:A retrospective analysis was carried out and enrolled,including 100 primary surgery and 14 second surgery.The data of 100 patients with primary surgery and 14 patients with reoperation were retrospectively analyzed.The criterion,predicting the success of surgery,is that the measured iPTH level declines by more than 80%compared with that before surgery,20 minutes after the last parathyroid gland removed.Serum calcium,serum phosphorus and iPTH tested pre-and post-operation were statistically analyzed.Result:112 cases(98 cases in the first operation and 14 cases in the second operation)were cured by operation and the cure rate is 98.2%.In 109 cases(97 cases of first operation and 12 cases of reoperation),the intraoperative determination of parathyroid hormone was up to standard,and the sensitivity of predicting the success of surgery was 97.0%and 85.7%,respectively.Postoperative clinical symptoms such as joint pain and skin itching,etc.were significantly improved or disappeared.Postoperative iPTH,serum calcium and serum phosphorus were significantly different from those before surgery,and the difference was statistically significant(P<0.05).Conclusion:Intraoperative parathyroid hormone monitoring has vital clinical guiding value for SHPT,and can improve the success rate significantly.A more than 80%reduction in iPTH at 20 min after the last parathyroidectomy was a good predictor of successful surgery.

关 键 词：甲状旁腺功能亢进 全段甲状旁腺激素 敏感度 

分 类 号：R582[医药卫生—内分泌]