Preoperative diagnosis and surgical strategies of primary hyperparathyroidism
10.3760/cma.j.issn.1674-6090.2018.04.003
- VernacularTitle:原发性甲状旁腺功能亢进症的术前诊断与外科治疗策略
- Author:
Xiang ZHANG
1
;
Ya HU
;
Mengyi WANG
;
Zhe SU
;
Quan LIAO
;
Yupei ZHAO
Author Information
1. 中国医学科学院北京协和医院基本外科
- Keywords:
Primary hyperparathyroidism;
Localizaion diagnosis;
Ultrasonography;
99Tcm-sestamibi;
Parathyroid surgery
- From:
Chinese Journal of Endocrine Surgery
2018;12(4):274-277
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the preoperative localizaion diagnosis and surgical strategies of primary hyperparathyroidism (pHPT).Methods The clinical data of pHPT patients who underwent initial parathyroid surgery at the Peking Union Medical College Hospital from Jan.2009 to Apr.2017 were retrospectively analyzed to explore preoperative localization and surgical options.Results There were a total of 902 surgical cases included in the study with 674 women and 228 men.All had preoperative parathyroid ultrasonography (US) (sensitivity 97.18％,positive predictive value (PPV) 98.40％) and 99Tcm-sestamibi (MIBI) scan (sensitivity 94.24％,PPV 98.00％).The combination of US and MIBI scan had a sensitivity of 92.39％ and PPV of 97.37％.MIBI scan showed negative results in 51 cases.We found that male patients with cystic lesions were more likely related to negative MIBI scan (P＜0.05).Among 89 patients with negative MIBI and/or US,39 received neck CT,17 received positron emission tomography (PET)/CT,and 9 received ultrasound-guided biopsy for further localization.800 patients (88.69％) underwent minimally invasive parathyroid surgery (MIP) with anesthesia of cervical plexus block.656 patients (72.72％) had normal parathyroid hormone (PTH) level on the first post-operative day,140 patients (15.52％) had postoperative hypocalcaemia and 234 patients (25.94％) presented hypocalcaemic symptoms within 3 days after operation,which could be relieved by intravenous calcium or continuous medicine taken by mouth.During the follow-up of the 800 MIP patients,4 had recurrence and one patient was not cured.Conclusions Parathyroid US and MIBI scan are of good value in localizaion diagnosis.Neck CT or PET/CT should be used as supplementary approaches in patients with negative US and/or MIBI scan.MIP with anesthesia of cervical plexus block is simple and feasiable for pHPT cases with accurate localization.
