Initial experience with intraoperative PTH determinations in the surgical management of 130 consecutive cases of primary hyperparathyroidism

被引:135
作者
Garner, SC [1 ]
Leight, GS [1 ]
机构
[1] Duke Univ, Med Ctr, Dept Surg, Durham, NC 27710 USA
关键词
D O I
10.1067/msy.2099.101429
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background, Successful surgical management of primary hyperparathyroidism (1 degrees HPT) historically has required bilateral neck exploration. The intraoperative parathyroid hormone (IO-PTH) assay allows a more limited procedure by confirming complete removal of hypersecreting tissue. Methods, Plasma samples were obtained from 130 consecutive patients both before (preincision and preexcision baselines) and at approximately 5 and 10 minutes (and additional times) after removal of abnormal parathyroid tissue. Samples were assayed for IO-PTH by a ma,icl, two-site immunochemiluminescent assay (ICMA) with a 7-minute incubation at 45 degrees C. Results, Plasma ITO-PTH decreased by at least 50% in 126 of 130 cases; however, three of these cases were false positives. The four cases in which IO-PTH fell <50% were classified as two true negatives and two false negatives. A single adenoma was removed in 125 cases, and true or three hyperplastic glands were removed in five cases. Conclusions. IO=PTH predicted the postoperative outcome in 125 of 130 cases (96.2%), including two of five cases in which multiple hyperplastic glands were removed, and 1 degrees HPT was successfully treated in 97.7% (127/130) of the cases. The IO-PTH procedure can provide valuable confirmation to the endocrine surgeon; however, other sources of information must also be used to ensure that all hyperplastic glands are identified.
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页码:1132 / 1137
页数:6
相关论文
共 15 条
[1]  
Bergenfelz A, 1998, BRIT J SURG, V85, P1129
[2]   Intraoperative parathyroid hormone monitoring as an adjunct to parathyroidectomy [J].
Boggs, JE ;
Irvin, GL ;
Molinari, AS ;
Deriso, GT .
SURGERY, 1996, 120 (06) :954-958
[3]   Concise parathyroidectomy:: The impact of preoperative SPECT 99mTc sestamibi scanning and intraoperative quick parathormone assay [J].
Carty, SE ;
Worsey, MJ ;
Virji, MA ;
Brown, ML ;
Watson, CG .
SURGERY, 1997, 122 (06) :1107-1114
[4]   Values of ultrasonography, sestamibi scintigraphy, and intraoperative measurement of 1-84 PTH for unilateral neck exploration of primary hyperparathyroidism [J].
Chapuis, Y ;
Fulla, Y ;
Bonnichon, P ;
Tarla, E ;
Abboud, B ;
Pitre, J ;
Richard, B .
WORLD JOURNAL OF SURGERY, 1996, 20 (07) :835-840
[5]   PARATHYROID ADENOMECTOMY UNDER LOCAL-ANESTHESIA WITH INTRAOPERATIVE MONITORING OF UCAMP AND OR 1-84 PTH [J].
CHAPUIS, Y ;
ICARD, P ;
FULLA, Y ;
NONNENMACHER, L ;
BONNICHON, P ;
LOUVEL, A ;
RICHARD, B .
WORLD JOURNAL OF SURGERY, 1992, 16 (04) :570-575
[6]   Intraoperative parathyroid hormone monitoring during parathyroidectomy for secondary hyperparathyroidism [J].
Clary, BM ;
Garner, SC ;
Leight, GS .
SURGERY, 1997, 122 (06) :1034-1038
[7]   OPERATIVE MONITORING OF PARATHYROID-GLAND HYPERFUNCTION [J].
IRVIN, GL ;
DEMBROW, VD ;
PRUDHOMME, DL .
AMERICAN JOURNAL OF SURGERY, 1991, 162 (04) :299-302
[8]  
IRVIN GL, 1993, SURGERY, V114, P1019
[9]   A NEW, PRACTICAL INTRAOPERATIVE PARATHYROID-HORMONE ASSAY [J].
IRVIN, GL ;
DERISO, GT .
AMERICAN JOURNAL OF SURGERY, 1994, 168 (05) :466-468
[10]  
Irvin GL, 1996, ARCH SURG-CHICAGO, V131, P1074