异位甲状旁腺术前术中定位方法分析  

Perioperative localization of ectopic functioning parathyroid gland in patients with hyperparathyroidism

作　　者：赵腾 魏伯俊[1] 刘星 申虹 王嘉程 王倩[1] 辛云慧 Zhao Teng;Wei Bojun;Liu Xing;Shen Hong;Wang Jiacheng;Wang Qian;Xin Yunhui(Department of Thyroid and Neck Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院甲状腺颈部外科,100020

出　　处：《中华普通外科杂志》2021年第6期446-450,共5页Chinese Journal of General Surgery

摘　　要：目的探讨术前术中定位方法在异位甲状旁腺功能亢进症(EHPT)诊治中的应用价值及其影响因素。方法回顾性分析205例原发性甲状旁腺功能亢进症(PHPT)中怀疑EHPT者^(99m)Tc-甲氧基异丁基异腈(^(99m)Tc-MIBI)显像、颈部超声、增强CT、术中局部静脉血甲状旁腺激素(IOLVPTH)测定结果。结果EHPT发生率为16.6%(34例),切除异位病灶36枚。异位于前上纵隔、甲状腺内、咽后、颈动脉鞘、椎前心包内的构成比分别为44.1%(15例)、29.49%(10例)、11.8%(4例)、5.9%(2例)、5.9%(2例)、2.9%(1例)。EHPT定位检查灵敏度分别为:增强CT 86.1%(31枚/36枚)、^(99m)Tc-MIBI显像66.7%(24枚/36枚)、颈部超声55.6%(20枚/36枚)、I0LVPTH测定61.8%(21枚/34枚)。增强CT定位深部异位病灶如纵隔咽后、椎前灵敏度均达100.0%,I0OLVPTH测定对甲状腺内异位病灶定位灵敏度100.0%。^(99m)Tc-MIBI显像、颈部超声联合应用对EHPT病灶定位灵敏度为77.8%。结论增强CT对EHPT定位诊断灵敏度较好。术前影像学检查和IOLVPTH测定联合应用有助于EHPT的定位诊断。Objective To investigate the value and influence factors of preoperative and intraoperative localization of ectopic hyperparathyroidism(EHPT).Methods Results of^(99m)Tc-sestamibi(^(99m)Tc-MIBI),neck ultrasound,contrast CT and intraoperative local venous parathyroid hormone(IOLVPTH)were retrospectively analyzed in 205 patients with primary hyperparathyroidism(PHPT)suspected of EHPT.Results Incidence of EHPT was 16.6%(34 cases),and 36 ectopic lesions were detected.The proportion of EHPT in antero-superior mediastinum,intrathyroidal,in the retropharyngeal region,in carotid sheath,in the prevertebral region and intrapericardial were 44.1%(15 cases),29.4%(10 cases),11.8%(4 cases),5.9%(2 cases),5.9%(2 cases)and 2.9%(1 cases),respectively.Contrast CT was the most sensitive(86.1%,31 lesions/36 lesions)for EHPT,followed by^(99m)Tc-MIBI(66.7%,24 lesions/36 lesions),IOLVPTH monitoring(61.8%,21 lesions/34 lesions)and neck ultrasound(55.6%,20 lesions/36 lesions).Contrast CT was most sensitive,100%in detecting deep-located EHPT lesions,whereas IOLVPTH had advantages in detecting intrathyroidal EHPT lesions,with a sensitivity of 100.0%.The combined use of^(99m)Tc-MIBI and neck ultrasound showed a sensitivity of 77.8%in the localization of EHPT.Conclusions Contrast CT is highly sensitive in the localization of EHPT.The combined use of preoperative imaging and IOLVPTH monitoring helps to higher localization for EHPT.

关 键 词：甲状旁腺功能亢进症 体层摄影术 X线计算机 诊断 

分 类 号：R73[医药卫生—肿瘤]