摘要
目的 研究99mTc-MIBI SPECT-CT显像联合超声检测在继发性甲状旁腺功能亢进症诊治中的应用价值.方法 回顾性分析医院行甲状旁腺全切术（tPTX）＋自体前臂移植术（AT）的慢性肾脏病5期（CKD-5期）患者86例（平均年龄54岁,平均透析龄7.2年）的临床资料,比较术前B超和SPECT-CT甲状旁腺定位与术中所见、术后病理结果情况及关系.结果 术后患者均一期甲级愈合,无切口出血、感染及声音嘶哑并发症.术前超声定位甲状旁腺198枚,SPECT定位甲状旁腺181枚,手术切除甲状旁腺共343枚.术后病理结果提示甲状旁腺增生224枚,甲状旁腺瘤119枚.3例合并甲状腺癌,同期手术切除.99mTc-MIBI SPECT/CT甲状旁腺显像敏感性为45.3％ -86.3％,对甲状腺上极和下极的甲状旁腺显像差异有统计学意义（P〈0.05）;99mTc-MIBI SPECT/CT甲状旁腺显像敏感性对〉1 cm和〈1 cm的甲状旁腺显像比较差异有统计学意义.结论 术前常规彩超检查及SPECT-CT检查定位是可行的方法,SPECT-CT是重要的继发性甲状旁腺功能亢进症甲状旁腺全切术加自体前臂移植术术前定位手段,前者意义重在甲状旁腺腺瘤或腺瘤样增生的诊断,后者重在对术中搜寻甲状旁腺的定位,二者综合应用,对临床指导tPTX具有重要意义.
Objective To study the application value of 99mTc-MIBI SPECT-CT imaging com-bined with ultrasound in diagnosis and treatment of secondary hyperparathyroidism. Methods The clini-cal data of 86 patients with chronic kidney disease （CKD-5）（average age of 54,average dialysis age of 7. 2 years）underwent total parathyroidectomy（tPTX）and forearm autotransplantation（AT）were retro-spectively analyzed. The relationship between preoperative ultrasound and SPECT parathyroid positioning seen with intraoperative and postoperative pathologic results were analyzed. Results Postoperative pa-tients all had perfect healing,there was no unexpected complications like bleeding,infection or hoarse. A total of 198 parathyroids were positioned by preoperative ultrasond,and 181 parathyroids were posi-tioned by SPECT,343 parathyroids were removed by surgery. Postoperative pathological results showed parathyroid hyperplasia in 224 cases,parathyroid adenoma in 119 cases,3 cases merged with thyroid cancer,and were removed by surgery at the same period. 99m Tc-MIBI SPECT/ CT parathyroid imaging sensitivity was 45. 3% to 86. 3%,and there was significant difference in the parathyroid imaging on the up and down pole of thyroid（P 〈 0. 05）. There were significant differences in the imaging sensitivity of 99mTc-MIBI SPECT/ CT for parathyroid between greater than 1 cm parathyroid and less than 1 cm parathy-roid. Conclusions The positioning of conventional ultrasonography and SPECT-CT examination before surgery is feasible method. SPECT/ CT is important preoperative parathyroid positioning method for sec-ondary hyperparathyroidism hysterectomy with forearm autograft,the former focuses on the significance of parathyroid adenoma andadenomatoid hyperplasia,the latter focuses on the intraoperative parathyroid search positioning,the two methods is of clinical significance for tPTX.
出处
《中国实用医刊》
2017年第24期40-43,共4页
Chinese Journal of Practical Medicine
基金
河南省郑州市科技局科技攻关计划（N2014S0053）
