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Localization and Surgical Treatment of Intrathyroidal Parathyroid Lesions in Patients with Primary Hyperparathyroidism
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摘要:
目的 回顾性分析甲状腺内异位甲状旁腺病变的定位诊断和手术治疗策略。 方法 检索2003年9月至2012年9月547例在北京协和医院接受手术治疗甲状旁腺功能亢进患者的临床资料, 分析甲状腺内异位甲状旁腺病变的发生率及临床诊治特点。 结果 547例因甲状旁腺功能亢进接受手术治疗的患者中7例经术中探查和术后病理证实为甲状腺内异位甲状旁腺。7例患者中1例术前出现高钙危象。7例患者术前超声均发现甲状腺内占位, 其中5例提示可能为甲状旁腺。6例患者术前行99Tcm甲氧基异丁基异腈(99Tcm methoxyisobutylisonitrile, 99Tcm MIBI)单光子发射计算机断层显像(single photon emission computed tomography, SPECT), 其中5例发现异常增高区域。5例患者术前行颈部CT发现甲状腺内类圆形病灶, 但无法诊断异位甲状旁腺。术后病理诊断甲状旁腺腺瘤4例, 甲状旁腺腺癌2例, 甲状旁腺增生1例。术后患者无复发迹象, 1例反复3次甲状旁腺手术患者术后出现轻微声音嘶哑。 结论 对甲状腺内异位甲状旁腺这类少见的病例, 术前诊断非常困难, 需结合多种定位手术, 提高手术疗效, 减少盲目探查的风险。 Abstract:Objective To investigate the strategy of diagnosis and surgery for intrathyroidal parathyroid lesions in patients with primary hyperparathyroidism. Methods The clinical data of patients with primary hyperparathyroidism who had undergone parathyroidectomy between September 2003 and September 2012 in Peking Union Medical College Hospital were retrospectively analyzed for intrathyroidal parathyroid lesions. Results Of 547 patients who had received surgical treatment due to primary hyperparathyroidism, 7(1.28%) were confirmed to be with intrathyroidal ectopic parathyroid by intraoperative exploration and postoperative pathology. Preoperative high-calcium crisis was noted in one of these seven cases. Ultrasound evaluation revealed lesion in thyroid in all seven patients before operations, and parathyroid was considered in five patients. 99Tcm methoxyisobutylisonitrile(99Tcm MIBI) single photon emission computed tomography (SPECT) was performed preoperatively in 6 patients, among whom 5 were found to be with abnormally hyperdense areas. Cervical computed tomography (CT) revealed intrathyroidal round-like lesions in 5 patients, although whether it was ectopic parathyroid could not be confirmed. Pathologic examinations of the resected lesions revealed adenoma (n=4), adenocacinoma (n=2), and hyperplasia (n=1). No relapse was noted after surgery. One patient who had repeatedly received three parathyroid surgeries developed mild hoarseness after the surgeries. Conclusions Intrathyroidal parathyroid lesions in patients with primary hyperparathyroidism are rare conditions and therefore their preoperative diagnoses can be challenging. Multiple localization techniques should be employed to improve the surgical effectiveness and increase the accuracy of localization. -
Key words:
- ectopic parathyroid /
- hyperparathyroidism /
- diagnosis /
- surgery
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[1] 张明, 朱精强, 魏涛.无症状型甲状腺内异位甲状旁腺瘤1例报道[J].中国普外基础与临床, 2011, 18:365. [2] Phitayakorn R, McHenry CR. Incidence and location of ectopic abnormal parathyroid glands[J]. Am J Surg, 2006, 191:418-423. [3] Goodman A, Politz D, Lopez J, et al. Intrathyroid parathyroid adenoma:incidence and location -the case against thyroid lobectomy[J]. Otolaryngol Head Neck Surg, 2011, 144:867-871. [4] Abboud B, Sleilaty G, Ayoub S, et al. Intrathyroid parathyroid adenoma in primary hyperparathyroidism:can it be predicted preoperatively?[J]. World J Surg, 2007, 31:817-823. [5] Feliciano DV. Parathyroid pathology in an intrathyroidal position[J]. Am J Surg, 1992, 164:496-500. [6] Tresoldi S, Pompili G, Maiolino R, et al. Primary hyperparathyroidism:can ultrasonography be the only preoperative diagnostic procedure?[J]. Radiol Med, 2009, 114:1159-1172. [7] Gómez-Ramírez J, Sancho-Insenser JJ, Pereira JA, et al. Impact of thyroid nodular disease on 99mTc-sestamibi scintigraphy in patients with primary hyperparathyroidism[J]. Langenbecks Arch Surg, 2010, 395:929-933. [8] Johnson NA, Tublin ME, Ogilvie JB. Parathyroid imaging:technique and role in the preoperative evaluation of primary hyperparathyroidism[J]. AJR Am J Roentgenol, 2007, 188:1706-1715. [9] Marmin C, Toledano M, Lemaire S, et al. Computed tomography of the parathyroids:the value of density measurements to distinguish between parathyroid adenomas of the lymph nodes and the thyroid parenchyma[J]. Diagn Interv Imaging, 2012, 93:597-603. [10] Cheung K, Wang TS, Farrokhyar F, et al. A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism[J]. Ann Surg Oncol, 2012, 19:577-583. [11] Yabuta T, Tsushima Y, Masuoka H, et al. Ultrasonographic features of intrathyroidal parathyroid adenoma causing primary hyperparathyroidism[J]. Endocr J, 2011, 58:989-994. [12] Serra A, Bolasco P, Satta L, et al. Role of SPECT/CT in the preoperative assessment of hyperparathyroid patients[J]. Radiol Med (Torino), 2006, 111:999-1008. [13] Akram K, Parker JA, Donohoe K, et al. Role of single photon emission computed tomography/computed tomography in localization of ectopic parathyroid adenoma:a pictorial case series and review of the current literature[J]. Clin Nucl Med, 2009, 34:500-502. [14] Pata G, Casella C, Besuzio S, et al. Clinical appraisal of 99m technetium-sestamibi SPECT/CT compared to conventional SPECT in patients with primary hyperparathyroidism and concomitant nodular goiter[J]. Thyroid, 2010, 20:1121-1127. [15] Paker I, Yilmazer D, Yandakci K, et al. Intrathyroidal oncocytic parathyroid adenoma:a diagnostic pitfall on fine-needle aspiration[J]. Diagn Cytopathol, 2010, 38:833-836. [16] Gough I. Reoperative parathyroid surgery:the importance of ectopic location and multigland disease[J]. ANZ J Surg, 2006, 76:1048-1050. [17] Cheng W, MacLennan GT, Lavertu P, et al. Giant intrathyroid parathyroid adenoma:a preoperative and intraoperative diagnostic challenge[J]. Ear Nose Throat J, 2009, 88:E1-3. [18] Sendt W, Spieker K, Michael G, et al.Radio-guided parathyroidectomy in patients with primary hyperparathyroidism and concomitant multinodular goiter[J]. Surg Today, 2010, 40:825-830. [19] Perrier ND, Ituarte P, Kikuchi S, et al. Intraoperative parathyroid aspiration and parathyroid hormone assay as an alternative to frozen section for tissue identification[J]. World J Surg, 2000, 24:1319-1322. [20] Herden U, Seiler CA, Candinas D, et al. Intrathyroid adenomas in primary hyperparathyroidism:are they frequent enough to guide surgical strategy?[J]. Surg Innov, 2011, 18:373-378. [21] Goodman A, Politz D, Lopez J, et al. Intrathyroid parathyroid adenoma:incidence and location-the case against thyroid lobectomy[J]. Otolaryngol Head Neck Surg, 2011, 144:867-871. -
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