原发性甲状旁腺功能亢进症患者术前病变甲状旁腺定位方法的评估

Assessment of Preoperative Localization Techniques for Patients with Primary Hyperparathyroidism

目的评价锝[^（99m）Tc]甲氧基异丁基异腈(99mTc-MIBI)显像及颈部超声对原发性甲状旁腺功能亢进症(primaryhyperparathyroidism,pHPT)患者在手术前进行病变甲状旁腺定位的敏感性和应用价值。方法对本院1983年6月到2002年6月期间收治的160例pHPT患者进行术前99mTc-MIBI显像检查和/或颈部超声检查。其中,男性53例(33.1%),女性107例(66.9%),平均年龄为(38.9±14.8)岁;100例接受99mTc-MIBI显像检查,148例进行高分辨率颈部超声检查。检查结果与手术所见和病理学进行比较。结果99mTc-MIBI显像和颈部超声对病变甲状旁腺定位的敏感性分别为94.0%和85.1%,阳性预测值分别为100%和89.1%,联合2种检查总的敏感性可达98.9%;在单个甲状旁腺病变组(n=145)中,99mTc-MIBI显像的敏感性为93.3%,颈部超声的敏感性为84.7%;甲状旁腺病变异位患者进行99mTc-MIBI显像的检测敏感性达100%,但是应用超声检测敏感性为56.3%。结论99mTc-MIBI显像和颈部超声对pHPT具有不同的敏感性,2种检查方法联合应用可以使敏感性增加。甲状旁腺异位对99mTc-MIBI显像的敏感性无影响,但是会使超声的敏感性下降,肿瘤大小影响超声检查敏感性,并且观察到99mTc-MIBI假阴性的各种原因,对于99mTc-MIBI检查阴性者应该排除可能的干扰因素。

Objective To evaluate the sensitivity and usefulness of 99m Tc-sestamibi scintigraphy (SS)and neck ultrasonography(US)as preoperative localization procedures in patients with primary hyperparathy-roidism (pHPT).Methods 160patients with proved pHPT in Peking Union Medical College Hospital from June1983to June2002were studied.There were107women(66.9%)and53men (33.1%),with a mean age of38.9years (10～73years).100patients were underwent SS and148patients were underwent US prior to surgery,and the results were compared with operative and histological findings.Results The sensitivity of SS and US in localization of the enlarged parathyroid glands was94.0%and85.1%respectively,and the positive predictive value of SS and US was100%and89.1%respectively,the overall sensitivity was98.9%by combination of SS and US.In solitary parathyroid adenomas group(n=145),the sensitivity of SS and US was93.3%and84.7%respectively;There was no significant difference (P=0.428)in sensitivity of SS between the parathyroid glands correctly identified and undetected in classical neck location as compared with ectopic parathyroid glands,whereas significantly (P=0.026)influenced by the US sensitivity.Conclusions Different sensitiv-ity exit between SS and VS in preoperative localization in patients with pHPT undergoing parathyro-idectomy.The combined use of SS and US could increase the sensitivity of localization technique.Ectopic parathyroid had no influence on the sensitivity of 99m Tc-MIBI scanning,but decreased the sensitivity of ultrasonography.The size of parathyroid tumors had effects on the sensitivity of ultrasonography.Otherwise,various conditions causing SS false negative were observed.Some interfere factors should be excluded when SS negative results were encountered in clinical practice.