PDF(Pubmed)
Abstract：
Primary hyperparathyroidism (pHPT) is the third most common endocrine disease. The surgical procedure aims for permanent cure, but recurrence has been reported in 4%-10% of pHPT patients. Preoperative localization imaging is highly valuable. It includes ultrasound, computed tomography (CT), single-photon-emission CT, sestamibi scintigraphy and magnetic resonance imaging. The operation has been defined as successful when postoperative continuous eucalcemia exists for more than the first six months. Ongoing hypercalcemia during this period is defined as persistence, and recurrence is defined as hypercalcemia after six months of normocalcemia. Vitamin D is a crucial factor for a good outcome. Intraoperative parathyroid hormone (PTH) monitoring can safely predict the outcomes and should be suggested. PTH ≤ 40 pg/mL or the traditional decrease ≥ 50% from baseline minimizes the likelihood of persistence. Risk factors for persistence are hyperplasia and normal parathyroid tissue on histopathology. Risk factors for recurrence are cardiac history, obesity, endoscopic approach and low-volume center (at least 31 cases/year). Cases with double adenomas or four-gland hyperplasia have a greater likelihood of persistence/ recurrence. A 6-mo calcium > 9.7 mg/dL and eucalcemic parathyroid hormone elevation at 6 mo may be associated with recurrence necessitating long-term follow-up. 18F-fluorocholine positron emission tomography and 4-dimensional CT in persistent and recurrent cases can be valuable before reoperation. With these novel advances in preoperative imaging and localization as well as intraoperative PTH measurement, the recurrence rate has dropped to 2.5%-5%. Six-month serum calcium ≥ 9.8 mg/dL and parathyroid hormone ≥ 80 pg/mL indicate a risk of recurrence. Negative sestamibi scintigraphy, diabetes and elevated osteocalcin levels are predictors of multiglandular disease, which brings an increased risk of persistence and recurrence. Bilateral neck exploration was considered the gold-standard diagnostic method. Minimally invasive parathyroidectomy and neck exploration are both effective surgical techniques. Multidisciplinary diagnostic and surgical management is required to prevent persistence and recurrence. Long-term follow-up, even up to 10 years, is necessary.
摘要：
原发性甲状旁腺功能亢进（pHPT）是第三大常见的内分泌疾病。外科手术旨在永久治愈，但据报道，有4%-10%的pHPT患者复发。术前定位成像非常有价值。它包括超声波，计算机断层扫描（CT），单光子发射CT,Sestamibi闪烁显像和磁共振成像。当术后持续的贫血超过前六个月时，该手术被定义为成功。在此期间持续的高钙血症被定义为持续性，复发定义为正常血钙6个月后的高钙血症。维生素D是良好结果的关键因素。术中甲状旁腺激素（PTH）监测可以安全地预测结果，应建议。PTH≤40pg/mL或传统的基线下降≥50%可使持续的可能性最小化。持续存在的危险因素是组织病理学上的增生和正常的甲状旁腺组织。复发的危险因素是心脏病史，肥胖，内镜入路和低容量中心（至少31例/年）。双腺瘤或四腺增生的病例有更大的持续/复发可能性。6个月钙>9.7mg/dL和6个月时的甲状旁腺激素升高可能与需要长期随访的复发有关。在持续和复发的病例中，18F-氟胆碱正电子发射断层扫描和4维CT在再次手术前可能是有价值的。随着术前成像和定位以及术中PTH测量的这些新进展，复发率已降至2.5%-5%。6个月血清钙≥9.8mg/dL和甲状旁腺激素≥80pg/mL提示复发风险。Sestamibi闪烁显像阴性,糖尿病和骨钙蛋白水平升高是多腺疾病的预测因子，这带来了持续和复发的风险增加。双侧颈部探查被认为是金标准诊断方法。微创甲状旁腺切除术和颈部探查术都是有效的手术技术。需要多学科诊断和手术管理以防止持续和复发。长期随访,甚至长达10年，是必要的。
