<sup>99</sup>TC<sup>m</sup>-甲氧基异丁基异腈在甲状旁腺切除术中定位诊断的效果评价

doi:10.3877/cma.j.issn.1674-0785.2019.06.005

目的

评价⁹⁹TC^m-甲氧基异丁基异腈（⁹⁹TC^m-MIBI）在继发性甲状旁腺功能亢进症患者甲状旁腺切除手术中定位诊断的效果。

方法

回顾性分析2012年2月至2018年9月在江苏省苏北人民医院肾内科行手术治疗的33例继发性甲状旁腺功能亢进症患者的临床资料。根据手术方法不同分为2组，术中接受⁹⁹TC^m-MIBI引导的甲状旁腺切除术者为Ⅰ组，术中未接受⁹⁹TC^m-MIBI引导者为Ⅱ组。分别统计2组手术时间、手术并发症等情况，并以手术前后生化指标变化、病理检查等为依据，分别计算手术缓解率、成功率、复发率及病理阳性率。采用t检验比较手术时间、手术前后血钙、血磷及术前血甲状旁腺激素（PTH）的组间和组内差异，采用非参数检验比较术后血PTH的组间和组内手术前后的差异，采用Fisher确切概率法比较手术成功率、缓解率、术后短期复发率及病理阳性率的组间差异。

结果

2组的手术时间及并发症的情况比较，差异无统计学意义（P>0.05）。2组患者术后第1天、1周、6个月的血钙、血磷、PTH均较术前降低，差异有统计学意义（P均<0.05）。Ⅰ组、Ⅱ组手术缓解率（100% vs 86.7%）及术后短期复发率（0% vs 7.7%）比较，差异均无统计学意义（P>0.05）。手术成功率（100% vs 73.3%）及病理阳性率（100% vs 92.7%）比较，差异均具有统计学意义（P=0.033，P=0.033）。

结论

⁹⁹TC^m-MIBI是一种有效可行的术中定位手段，采用⁹⁹TC^m-MIBI引导下的甲状旁腺切除术治疗继发性甲状旁腺功能亢进，能达到更高的病理阳性率，提高手术成功率。同时，因⁹⁹TC^m-MIBI更精确的定位，理论上或可降低术后短期复发率及术后并发症的发生率，替代术中病理，以缩短手术时间。

关键词: 继发性甲状旁腺功能亢进症, 甲状旁腺切除术, 甲状旁腺激素, ⁹⁹TC^m-甲氧基异丁基异腈

Objective

To evaluate the effect of ⁹⁹Tc^m-methoxyisobutylisonitrile (⁹⁹Tc^m-MIBI) in intraoperative localization during parathyroidectomy for secondary hyperparathyroidism patients.

Methods

Clinical data of 33 patients who underwent parathyroidectomy for secondary hyperparathyroidism at the Department of Nephrology, Jiangsu Subei People's Hospital from February 2012 to September 2018 were reviewed retrospectively. Patients were divided into two groups according to operative method, namely, patients undergoing parathyroidectomy with ⁹⁹Tc^m-MIBI guidance (groupⅠ) and those undergoing parathyroidectomy without ⁹⁹Tc^m-MIBI guidance (groupⅡ). Operative time and complications were collected, and the remission rate, successful rate, recurrence rate, and pathological positive rate were calculated by biochemical indexes and pathological results. The t-test was used to compare the intra- and inter-group differences of operative time, blood calcium and phosphorus, and preoperative blood parathyroid hormone (PTH), non-parametric tests were used to compare the intra-and inter-group differences of postoperative blood PTH, and the Fisher's exact probability method was used to compare the differences of success, remission, short-term recurrence, and pathological positive rates.

Results

There was no significant difference in operation time or complications between the two groups (P>0.05). The levels of serum calcium, phosphorus, and PTH in the two groups on the 1st day, 1st week, and 6th month after operation were significantly lower than those before operation (P<0.05). There was no significant difference in remission rate (100% vs 86.7%) or short-term recurrence rate (0% vs 7.69%) between groupsⅠandⅡ(P>0.05), although the successful rate of operation (100% vs 73.3%) and pathological positive rate (100% vs 92.7%) were significantly different between the two groups (P=0.033, P=0.033).

Conclusions

Compared with parathyroidectomy without ⁹⁹Tc^m-MIBI guidance, intraoperative ⁹⁹Tc^m-MIBI radio-guided parathyroidectomy for secondary hyperparathyroidism can achieve higher pathological positive rate and improve the successful rate of operation, and reduce the incidence of recurrence and complications theoretically by localizing the lesions more accurately. ⁹⁹Tc^m-MIBI guidance may replace intraoperative pathology to reduce the operative time and is an effective and feasible method for intraoperative localization during parathyroidectomy.

Key words: Secondary hyperparathyroidism, Parathyroidectomy, Parathyroid hormone, ⁹⁹Tc^m-methoxyisobutylisonitrile

表1 2组慢性肾衰竭合并继发性甲状旁腺功能亢进患者一般临床资料比较

组别	例数	性别（男/女）	年龄（岁，±s）	透析龄（岁，±s）
Ⅰ组	18	8/10	49±9	7.7±3.7
Ⅱ组	15	8/7	49±14	6.8±3.3
统计值	?	-	t=-0.039	t=0.684
P值	?	0.732	0.969	0.499

表1 2组慢性肾衰竭合并继发性甲状旁腺功能亢进患者一般临床资料比较

组别	例数	性别（男/女）	年龄（岁，±s）	透析龄（岁，±s）
Ⅰ组	18	8/10	49±9	7.7±3.7
Ⅱ组	15	8/7	49±14	6.8±3.3
统计值	?	-	t=-0.039	t=0.684
P值	?	0.732	0.969	0.499

表2 2组慢性肾功能衰竭合并SHPT患者手术时间及手术前后实验室检查的比较

组别	例数	手术时间（min，±s）	术前			术后第1天
组别	例数	手术时间（min，±s）	血钙（mmol/L，±s）	血磷（mmol/L，±s）	血PTH（ng/L，±s）	血钙（mmol/L，±s）	血磷（mmol/L，±s）	血PTH［ng/L，M（Q_R）］
Ⅰ组	18	69±16	2.52±0.24	2.54±0.74	1642±509	2.02±0.28^a	2.35±0.61^a	43.31 （21.15，65.37）^a
Ⅱ组	15	78±17	2.47±0.23	1.96±0.55	2307±871	1.96±0.24^a	1.60±0.56^a	59.11（34.21，573.20）^a
t值	?	-1.626	0.645	2.513	-2.732	0.652	3.633	-
P值	?	0.114	0.524	0.017	0.010	0.519	0.001	0.126
组别	例数	术后1周			术后6个月
组别	例数	血钙（mmol/L，±s）	血磷（mmol/L，±s）	血PTH［ng/L，M（Q_R）］	血钙（mmol/L，±s）	血磷（mmol/L，±s）	血PTH［ng/L，M（Q_R）］
Ⅰ组	18	1.82±0.29^a	1.37±0.50^ab	46.12（18.16，119.20）^a	1.84±0.33^a	1.56±0.54^a	45.60（42.34，58.79）^a
Ⅱ组	15	1.96±0.28^a	1.12±0.47^ab	58.87（25.19，999.60）^a	1.98±0.38^a	1.16±0.52^a	107.41（52.18，594.53）^a
t值	?	-1.427	1.370	-	-0.796	1.527	-
P值	?	0.164	0.182	0.361	0.436	0.144	0.091

表2 2组慢性肾功能衰竭合并SHPT患者手术时间及手术前后实验室检查的比较

组别	例数	手术时间（min，±s）	术前			术后第1天
组别	例数	手术时间（min，±s）	血钙（mmol/L，±s）	血磷（mmol/L，±s）	血PTH（ng/L，±s）	血钙（mmol/L，±s）	血磷（mmol/L，±s）	血PTH［ng/L，M（Q_R）］
Ⅰ组	18	69±16	2.52±0.24	2.54±0.74	1642±509	2.02±0.28^a	2.35±0.61^a	43.31 （21.15，65.37）^a
Ⅱ组	15	78±17	2.47±0.23	1.96±0.55	2307±871	1.96±0.24^a	1.60±0.56^a	59.11（34.21，573.20）^a
t值	?	-1.626	0.645	2.513	-2.732	0.652	3.633	-
P值	?	0.114	0.524	0.017	0.010	0.519	0.001	0.126
组别	例数	术后1周			术后6个月
组别	例数	血钙（mmol/L，±s）	血磷（mmol/L，±s）	血PTH［ng/L，M（Q_R）］	血钙（mmol/L，±s）	血磷（mmol/L，±s）	血PTH［ng/L，M（Q_R）］
Ⅰ组	18	1.82±0.29^a	1.37±0.50^ab	46.12（18.16，119.20）^a	1.84±0.33^a	1.56±0.54^a	45.60（42.34，58.79）^a
Ⅱ组	15	1.96±0.28^a	1.12±0.47^ab	58.87（25.19，999.60）^a	1.98±0.38^a	1.16±0.52^a	107.41（52.18，594.53）^a
t值	?	-1.427	1.370	-	-0.796	1.527	-
P值	?	0.164	0.182	0.361	0.436	0.144	0.091

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Effect of ⁹⁹Tc^m-MIBI in intraoperative localization during parathyroidectomy

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Effect of 99Tcm-MIBI in intraoperative localization during parathyroidectomy

Effect of ⁹⁹Tc^m-MIBI in intraoperative localization during parathyroidectomy