Background The value of gamma probes in the surgical treatment of secondary hyperparathyroidism （sHPT） was determined.The aim of this study was to enhance the rate of successful total parathyroidectomy in patients w...Background The value of gamma probes in the surgical treatment of secondary hyperparathyroidism （sHPT） was determined.The aim of this study was to enhance the rate of successful total parathyroidectomy in patients with sHPT using intraoperative gamma probe investigations.Methods We retrospectively analyzed the clinical data of 48 sHPT patients between May 2007 and September 2011.Preoperative 99Tcm-methoxyisobutyl isonitrile （MIBI） scintigraphy and high-frequency ultrasonography were used for parathyroid localization.Thirty-five patients （group Ⅰ） underwent conventional neck exploration and open parathyroidectomy.Thirteen patients （group Ⅱ） underwent gamma probe-guided total parathyroidectomy and parathyroid transplantation.The two groups were compared in terms of the number of parathyroid resections,operative time,and postoperative changes in the blood levels of parathyroid hormone （PTH）,calcium,and phosphate.Results The clinical manifestations,PTH and calcium levels,age distribution,and clinical characteristics did not differ between the two groups.The accuracy of preoperative 99Tcm-MIBI scintigraphy （89.74％） for the diagnosis of hyperparathyroidism did not differ from that of ultrasonography （81.25％）.However,the accuracy of 99TcmMIBI scintigraphy （66.67％） for localizing hyperfunctioning parathyroids was significantly lower than that of ultrasonography （76.86％）.The operation time was significantly longer in group Ⅰ （（120±25） minutes） than in group Ⅱ （（90±30） minutes）.The accuracy of parathyroid identification was significantly higher in group Ⅱ （92.59％） than in group Ⅰ （80.39％）.On average,significantly fewer parathyroid specimens were obtained in group Ⅰ （2.5±0.5） than in group Ⅱ （3.5±0.5）.Compared with group Ⅰ,group Ⅱ showed a significant increase （15.4％） in the number of parathyroid resections.The PTH,calcium,and phosphate levels significantly decreased postoperatively in all patients.Conclusions Intra展开更多
目的探讨神经监测技术在继发性甲状旁腺功能亢进手术中的应用。方法回顾性分析手术治疗继发性甲状旁腺功能亢进病人59例,术中均应用神经监测技术。结果术后喉返神经(RLN)损伤暂时性损伤1例(1.6%,1/59),喉镜见左侧声带固定于旁正中位,术...目的探讨神经监测技术在继发性甲状旁腺功能亢进手术中的应用。方法回顾性分析手术治疗继发性甲状旁腺功能亢进病人59例,术中均应用神经监测技术。结果术后喉返神经(RLN)损伤暂时性损伤1例(1.6%,1/59),喉镜见左侧声带固定于旁正中位,术后6周双侧声带运动对称、闭合良好。术后无喉上神经及迷走神经损伤症状的病例。在神经监测技术保护下,本组共切除异常甲状旁腺236枚,术中甲状旁腺的位置对RLN损伤没有统计学意义(P>0.05)。异常甲状旁腺平均长径≥2 cm的81枚,其中1例(0.7%)出现RLN损伤;平均长径<2 cm甲状旁腺134枚,无RLN损伤,异常甲状旁腺大小对RLN损伤没有统计学意义(P>0.05)。手术时间≥1.5 h 43例,<1.5 h 16例,术后一日咽部不适47例,无咽部不适12例,手术时间长短并不是出现RLN损伤的原因,是出现术后出现咽喉部不适的因素(P<0.05)。结论对继发性甲状旁腺功能亢进病人,术中常规应用神经监测技术对降低喉神经损伤并发症,缩短手术时间有显著应用价值。展开更多
Secondary hyperthyroidism(SHPT)is a common complication of maintenance hemodialysis(MHD).In China the prevalence of chronic kidney disease(CKD)is 10.8%and there are about 0.2 million patients treated with maintenance ...Secondary hyperthyroidism(SHPT)is a common complication of maintenance hemodialysis(MHD).In China the prevalence of chronic kidney disease(CKD)is 10.8%and there are about 0.2 million patients treated with maintenance hemodialysis.These number are still increasing.Cinacalcet is a new calcium sensing receptor agonist to treat SHPT and the first calcimimetics be approved by Food and Drug Administration(FDA)to treat human.It can activate the calcium sensing receptor in parathyroid to improving control of parathyroid hormone(PTH),serum calcium,phosphorus,and calcium phosphorus product.Then decrease vascular calcification and parathyroid gland volume and reduce the occurrence of fracture and calcific uremic arteriolopathy(CUA).A better understanding of the clinical evaluation for Cinacalcet will hopefully help us to reduce the incidence of SHPT.展开更多
文摘Background The value of gamma probes in the surgical treatment of secondary hyperparathyroidism （sHPT） was determined.The aim of this study was to enhance the rate of successful total parathyroidectomy in patients with sHPT using intraoperative gamma probe investigations.Methods We retrospectively analyzed the clinical data of 48 sHPT patients between May 2007 and September 2011.Preoperative 99Tcm-methoxyisobutyl isonitrile （MIBI） scintigraphy and high-frequency ultrasonography were used for parathyroid localization.Thirty-five patients （group Ⅰ） underwent conventional neck exploration and open parathyroidectomy.Thirteen patients （group Ⅱ） underwent gamma probe-guided total parathyroidectomy and parathyroid transplantation.The two groups were compared in terms of the number of parathyroid resections,operative time,and postoperative changes in the blood levels of parathyroid hormone （PTH）,calcium,and phosphate.Results The clinical manifestations,PTH and calcium levels,age distribution,and clinical characteristics did not differ between the two groups.The accuracy of preoperative 99Tcm-MIBI scintigraphy （89.74％） for the diagnosis of hyperparathyroidism did not differ from that of ultrasonography （81.25％）.However,the accuracy of 99TcmMIBI scintigraphy （66.67％） for localizing hyperfunctioning parathyroids was significantly lower than that of ultrasonography （76.86％）.The operation time was significantly longer in group Ⅰ （（120±25） minutes） than in group Ⅱ （（90±30） minutes）.The accuracy of parathyroid identification was significantly higher in group Ⅱ （92.59％） than in group Ⅰ （80.39％）.On average,significantly fewer parathyroid specimens were obtained in group Ⅰ （2.5±0.5） than in group Ⅱ （3.5±0.5）.Compared with group Ⅰ,group Ⅱ showed a significant increase （15.4％） in the number of parathyroid resections.The PTH,calcium,and phosphate levels significantly decreased postoperatively in all patients.Conclusions Intra
文摘目的探讨神经监测技术在继发性甲状旁腺功能亢进手术中的应用。方法回顾性分析手术治疗继发性甲状旁腺功能亢进病人59例,术中均应用神经监测技术。结果术后喉返神经(RLN)损伤暂时性损伤1例(1.6%,1/59),喉镜见左侧声带固定于旁正中位,术后6周双侧声带运动对称、闭合良好。术后无喉上神经及迷走神经损伤症状的病例。在神经监测技术保护下,本组共切除异常甲状旁腺236枚,术中甲状旁腺的位置对RLN损伤没有统计学意义(P>0.05)。异常甲状旁腺平均长径≥2 cm的81枚,其中1例(0.7%)出现RLN损伤;平均长径<2 cm甲状旁腺134枚,无RLN损伤,异常甲状旁腺大小对RLN损伤没有统计学意义(P>0.05)。手术时间≥1.5 h 43例,<1.5 h 16例,术后一日咽部不适47例,无咽部不适12例,手术时间长短并不是出现RLN损伤的原因,是出现术后出现咽喉部不适的因素(P<0.05)。结论对继发性甲状旁腺功能亢进病人,术中常规应用神经监测技术对降低喉神经损伤并发症,缩短手术时间有显著应用价值。
基金Guangdong Obers Blood Purification Aca demi cian Work station(2013B090400004)Guangdong University blood purifica tion technology and Engineering Re search Center(GCZX-A1104)+1 种基金Guangzhou en trepreneurial leader talent/LCY201215Guangdong Provincial Center for clinical engineer ing of blood purification(507204531040)
文摘Secondary hyperthyroidism(SHPT)is a common complication of maintenance hemodialysis(MHD).In China the prevalence of chronic kidney disease(CKD)is 10.8%and there are about 0.2 million patients treated with maintenance hemodialysis.These number are still increasing.Cinacalcet is a new calcium sensing receptor agonist to treat SHPT and the first calcimimetics be approved by Food and Drug Administration(FDA)to treat human.It can activate the calcium sensing receptor in parathyroid to improving control of parathyroid hormone(PTH),serum calcium,phosphorus,and calcium phosphorus product.Then decrease vascular calcification and parathyroid gland volume and reduce the occurrence of fracture and calcific uremic arteriolopathy(CUA).A better understanding of the clinical evaluation for Cinacalcet will hopefully help us to reduce the incidence of SHPT.
