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.
作者
赵腾
魏伯俊
刘星
申虹
王嘉程
王倩
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)
出处
《中华普通外科杂志》
CSCD
北大核心
2021年第6期446-450,共5页
Chinese Journal of General Surgery
