甲状旁腺及其周围组织在^99mTc-MIBI引导的甲状旁腺切除术中放射性差异的研究

Study of radioactivities in parathyroid and near tissues during radioguided parathyroidectomy

目的比较甲状旁腺及周围不同组织在^99锝标记的甲氧基异丁基异腈（99mTc．MIBI）引导的甲状旁腺切除术中的放射性差异，并探讨99mTc—MIBI引导的甲状旁腺切除术治疗术前甲状旁腺显像假阴性患者的可行性。方法2010年8月至2011年8月，对21例甲状旁腺功能亢进症患者行99mTc—MIBI引导的甲状旁腺切除术。比较手术前后患者的血清甲状旁腺素、血钙水平；比较甲状腺、甲状旁腺、脂肪等组织的放射量；按术前甲状旁腺显像结果分为阳性组和阴性组，术中比较其体内外放射量的差异。采用t检验和方差分析方法进行统计学处理。结果术前2l例患者的血清甲状旁腺素值为（2071．5±504．4）ng／L，血钙为（2．48-l-0．31）mmoL／L；术后第1天血清甲状旁腺素值为（37．5±90．1）ng／L，血钙为（1．74±0．14）mmol／L。（t’=17．71，t=10．00，P〈0．001）；异常的甲状旁腺组织体内、体外放射性计数明显高于甲状腺与脂肪组织（F=75．25，F：37．81，P〈0．001）；所有增生的甲状旁腺腺体其体外放射性计数均大于背景的20％。结论”“Te．MIBI引导的甲状旁腺切除术中甲状旁腺、甲状腺、脂肪组织的放射性有明显差别，术中通过99mTc-MIBI的引导可以更直接地辨别异常的甲状旁腺，且比双时相甲状旁腺显像定位更敏感、更准确。

Objective To determine the radioactivities in parathryoid and near tissues during radioguided parathyroidectomy in patients with hyperparathyroidism and the utility of parathyroidectomy in patients with negative 99mTc-sestamibi scans. Methods Between August 2010 and August 2011,21 patients underwent radioguided parathyroidectomy for hyperthyroidism. The levels of parathyroid hormone （PTH） and serum calcium before and after surgery were detected parathyroid and near tissues were examined. According respectively. In vivo and ex vivo radioactivities in to the radioactivity in parathyroid, the patients were divided into two groups, positive group and negative group. All data was descriptively analyzed and underwent a t test and an analysis of variance. Results In all patients both PTH and calcium levels decreased significantly after parathyroidectomy when compared to those before surgery （t＇ = 17.71 and t = 10. 00, respectively, P 〈0. 001）. In vivo and ex vivo radioactivities in enlarged parathyroid glands were higher than those in thyroid and fat tissue （ F = 75.25 and 37.81, respectively, P 〈 0.001 ）. In vivo and ex vivo radioactivities of the enlarged parathyroid with negative sestamibi scans were significantly greater than background radioactivity. Conclusions There are significant differences in 99~ Tc-sestamibi radioactivities among enlarged parathyroid glands, thyroid glands and fat tissues. This radioguided technique is helpful to identify abnormal parathyroid gland in patients with hyperparathyroidism during parathyroidectomy.