99m Tc-甲氧基异丁基异腈引导甲状旁腺切除术对继发性甲状旁腺功能亢进的疗效分析  

Efficacy of parathyroidectomy guided by 99m Tc-methoxy isobutyl isonitrile on secondary hyperparathyroidism

作　　者：徐栋 陈隽[1] 周佳青[1] 王家东[1] XU Dong;CHEN Jun;ZHOU Jiaqing;WANG Jiadong(Department of Head and Neck Surgery,Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200001,China)

机构地区：[1]上海交通大学医学院附属仁济医院头颈外科,上海200001

出　　处：《中国眼耳鼻喉科杂志》2020年第6期451-455,共5页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：上海交通大学“医工交叉研究基金”(YG2017QN45)。

摘　　要：目的比较甲状旁腺切除术与锝99标记的甲氧基异丁基异腈(99m Tc-MIBI)引导甲状旁腺切除术治疗继发性甲状旁腺功能亢进对生化及骨密度指标的影响。方法分析127例行甲状旁腺全切除合并前臂移植术的继发性甲状旁腺功能亢进患者,其中60例对照组行传统甲状旁腺全切除联合前臂移植术,67例实验组在99m Tc-MIBI引导下行甲状旁腺切除联合前臂移植术。比较2组患者术前、术后甲状旁腺激素、血钙、血磷、碱性磷酸酶等生化指标及骨密度指标的变化。结果对照组有10例患者复发,实验组有2例患者复发。2组患者术后生化及骨密度指标均有明显改善(P值均<0.05)。实验组术后生化指标明显低于对照组(P值均<0.05),实验组腰4节段T评分改善程度明显高于对照组(P=0.029)。结论与传统手术相比,99m Tc-MIBI引导甲状旁腺切除术能更大程度地降低甲状旁腺激素水平,改善血钙、血磷代谢,提高腰4节段的T评分,且复发率更低。Objective To compare the effects of parathyroidectomy and 99m Tc-methoxy isobutyl isonitrile(MIBI)guided parathyroidectomy on biochemical examination and bone mineral density in patients with secondary hyperparathyroidism.Methods Data of 127 patients with secondary hyperparathyroidism who underwent total parathyroidectomy and forearm transplantation were analyzed.Among them,60 patients in the control group were treated with traditional total parathyroidectomy and forearm transplantation,and 67 patients in the experimental group were treated with parathyroidectomy and forearm transplantation under the guidance of 99m Tc-MIBI.The changes of biochemical examination such as parathyroid hormone,serum calcium,serum phosphorus,alkaline phosphatase and bone mineral density were compared between the two groups before and after operation.Results There were 10 cases of recurrence in the control group and 2 cases in the experimental group.The biochemical examination data and bone mineral density were all significantly improved in both groups(all P<0.05).The postoperative biochemical examination data in the experimental group were significantly lower than those in the control group(all P<0.05),and the T score of L4 segments in the experimental group was significantly higher than that in the control group(P<0.05).Conclusions The biochemical and bone mineral density data of the two groups were all improved in different degrees.Compared with traditional operation,99m Tc-MIBI guided parathyroidectomy can reduce parathyroid hormone level to a greater extent,improve blood calcium and phosphorus metabolism,increase T score of L4 segments,and have a lower recurrence rate.

关 键 词：继发性甲状旁腺功能亢进 甲状旁腺切除术 锝99标记的甲氧基异丁基异腈 

分 类 号：R653[医药卫生—外科学]