γ射线探测仪导航在继发性甲状旁腺功能亢进手术中的应用研究

Application ofγ-ray detector guidance in the surgery of secondary hyperparathyroidism

目的研究γ射线探测仪导航在继发性甲状旁腺功能亢进手术[甲状旁腺全切术+前臂自体移植术(TPTX+AT)]中的作用。方法3例行甲状旁腺全切术+前臂自体移植术的继发性甲状旁腺功能亢进患者,均在γ射线探测仪引导下行甲状旁腺全切术+前臂自体移植术。统计分析患者手术时间、甲状旁腺检出准确率、临床症状及手术前后血全段甲状旁腺激素(iPTH)、血钙、血磷水平和复发情况、术后并发症发生情况。结果3例患者平均手术时间为(55.23±13.21)min。3例患者经手术切除甲状旁腺总数为12枚,3例患者发现各有4枚甲状旁腺增生,未发现异位增生的甲状旁腺。11枚增生的甲状旁腺被γ射线探测仪识别并切除,病理证实为甲状旁腺,增生甲状旁腺γ射线计数增高比例为91.7%(11/12)。所有患者术后各种临床症状得到明显改善,手术后1周内患者的皮肤瘙痒、骨骼疼痛、肌肉无力等各种临床症状基本缓解,睡眠、食欲明显改善,经过长期随访,患者的日常生活质量明显得到提高。3例患者术后第1天血iPTH均<75 ng/L,且术后血钙、血磷水平逐步降低。3例患者随访至今无一例复发。3例患者均未发生神经组织损伤,3例患者术后均出现低血钙,1例患者出现急性左心衰,经对症治疗后好转。结论γ射线探测仪引导下的甲状旁腺全切术+前臂自体移植术对继发性甲状旁腺功能亢进有较好的疗效,γ射线探测仪导航能更好地发现增生的甲状旁腺,减少手术时间,提高手术疗效,是一种极其有效并安全的手术治疗方法。

Objective To study the role ofγ-ray detector guidance in the surgery of secondary hyperparathyroidism[total parathyroidectomy+autologous transplantation of forearm(TPTX+AT)].Methods 3 patients with secondary hyperparathyroidism underwent total parathyroidectomy+autologous transplantation of forearm,all of which were guided byγ-ray detector.The surgery time,parathyroid detection accuracy,clinical symptoms,blood intact parathyroid hormone(iPTH),blood calcium,blood phosphorus levels,recurrence before and after the surgery,and postoperative complications were statistically analyzed.Results The average surgery time of the 3 patients was(55.23±13.21)min.The total number of parathyroids removed from the 3 patients was 12,where 4 parathyroid hyperplasia were found in each one of the 3 patients,and no ectopic hyperplastic parathyroids was found.11 hyperplastic parathyroids were removed after being identified byγ-ray detector.They were pathologically confirmed as hyperplastic parathyroids.Theγ-ray count of hyperplastic parathyroids increased by a rate of 91.7%(11/12).Various clinical symptoms of all patients were significantly improved after the surgery.Within 1 week after the surgery,various clinical symptoms,such as skin pruritus,bone pain and muscle weakness,were basically relieved,and their sleep and appetite were significantly improved.After long-term follow-up,the quality of daily life of patients was significantly improved.3 patients had blood iPTH<75 ng/L on the first day after the surgery,and the levels of blood calcium and blood phosphorus decreased gradually.There was no recurrence in 3 patients during the follow-up hitherto.3 patients had no nerve tissue injury;3 patients had hypocalcemia after the surgery;and 1 patient had acute left heart failure;which were improved after the symptomatic treatment.Conclusion Total parathyroidectomy+autologous transplantation of forearm with guidance ofγ-ray detector has a good efficacy on secondary hyperparathyroidism.Withγ-ray detector guidance,hyperplastic parathyroids could be found easily,the surgery time was shortened,and the efficacy of the surgery was improved.Thus,it is a very effective and safe surgical method.