■原发性甲状旁腺功能亢进(PHPT)是第三大最常见的内分泌疾病。甲状旁腺切除术,据报道,初次手术的治愈率超过95%。异常甲状旁腺的定位对于手术成功至关重要。这项研究的目的是分析接受微创甲状旁腺切除术(MIP)和术中甲状旁腺激素监测(IOPTH)的单腺疾病(SGD)和阳性一致定位成像患者的数据,以评估IOPTH在局限性SGD患者中是否仍然合理。
■回顾性数据库分析了2016-2021年期间在超声(US)和99mTc-sestamibi闪烁显像(MIBI)中使用IOPTH进行PHPT和阳性一致定位的所有微创手术。当美国和MIBI都为阴性时,患者接受胆碱或蛋氨酸PET-CT.患者也在不应用IOPTH的情况下进行了第二次分析。
■总共,198名患者被纳入研究。美国的敏感性,MIBI和PET-CT为96%,94%和100%,分别。阳性预测值为88%,89%和94%与美国,MIBI和PET-CT,分别。185例(93.4%)患者IOPTH为真阳性。在13例(6.6%)患者中,在定位和切除假定的甲状旁腺增大后,未观察到足够的IOPTH下降.没有IOPTH,治愈率从195例(98.5%)下降到182例(92%),持续性疾病发生率从2例(1.0%)上升到15例(7.5%).
■停止IOPTH会使合并局部腺瘤患者的持续率增加7.5倍。因此,即使对于这组患者,IOPTH似乎仍然是必要的。
UNASSIGNED: Primary hyperparathyroidism (PHPT) is the third most common endocrine disease. With parathyroidectomy, a cure rate of over 95% at initial surgery is reported. Localization of the abnormal parathyroid gland is critical for the operation to be successful. The aim of this study is to analyze data of patients with single gland disease (SGD) and positive concordant localization imaging undergoing minimally invasive parathyroidectomy (MIP) and intraoperative parathyroid hormone monitoring (IOPTH) to evaluate if IOPTH is still justified in patients with localized SGD.
UNASSIGNED: A retrospective database analysis of all minimally invasive operations with IOPTH for PHPT and positive concordant localization in ultrasound (US) and 99mTc-sestamibi scintigraphy (MIBI) between 2016-2021. When both US and MIBI were negative, patients underwent either choline or methionine PET-CT. The patients were also analyzed a second time without applying IOPTH.
UNASSIGNED: In total, 198 patients were included in the study. The sensitivity of US, MIBI and PET-CT was 96%, 94% and 100%, respectively. Positive predictive value was 88%, 89% and 94% with US, MIBI and PET-CT, respectively. IOPTH was true positive in 185 (93.4%) patients. In 13 (6.6%) patients, no adequate IOPTH decline was observed after localizing and extirpating the assumed enlarged parathyroid gland. Without IOPTH, the cure rate decreased from 195 (98.5%) to 182 (92%) patients and the rate of persisting disease increased from 2 (1.0%) to 15 (7.5%) patients.
UNASSIGNED: Discontinuing IOPTH significantly increases the persistence rate by a factor of 7.5 in patients with concordantly localized adenoma. Therefore, IOPTH appears to remain necessary even for this group of patients.