观察异位甲状旁腺的分布特点及99m锝-甲氧异腈（^99mTc-MIBI）SPECT/CT和超声在异位甲状旁腺检查中的检出差异。

2013年7月至2018年7月中日友好医院在门诊或住院部对继发性甲状旁腺功能亢进症患者的回顾性分析显示，358例患者同时或超声检查后又完成了^99mTc-MIBI SPECT/CT检查，38例患者出现甲状旁腺异位。收集患者临床资料，分析甲状旁腺异位分布特点，比较^99mTc-MIBI SPECT/CT及超声对甲状旁腺异位的检测效能。

358例患者中检出异位甲状旁腺38例，检出率为10.61%。异位甲状旁腺的分布：前纵隔和胸腺内25（65.8%）、甲状腺下极下方2（5.3%）、环状软骨后1（2.6%）、甲状腺中叶外侧1（2.6%）、锁骨上窝1（2.6%）、颈动脉鞘内1（2.6%）、胸锁乳突肌后方1（2.6%）、颌下腺后1（2.6%）、梨状窝1（2.6%）、舌骨大角1（2.6%）、气管食管沟2（5.3%）、甲状腺内1（2.6%）、锁骨下动脉1例（2.6%）。^99mTc-MIBI SPECT/CT发现的38例异位甲状旁腺中超声仅仅发现了13例（34.2%）；SPECT/CT检出的25例前纵膈和胸腺内异位甲状旁腺，超声检出了4例（16.0%），超声对位置较深的甲状旁腺检出能力差。手术情况：38例患者共行外科手术60次（其中包括46例次普通外科手术、7例次胸腔镜手术、7例次超声引导下微波热消融手术），仍有10例患者未切除掉异位甲状旁腺，需再次手术，未切除的甲状旁腺均为胸腔内异位。

甲状旁腺异位的高发是甲状旁腺手术失败的主要原因，尤其是纵隔或胸腺异位。^99mTc-MIBI SPECT/CT是发现异位甲状旁腺的理想检查方法，尤其对于纵隔或胸腺异位甲状旁腺，^99mTc-MIBI SPECT/CT明显优于超声。

To observe the distribution characteristics of ectopic parathyroid glands and explore the difference of ^99mTc-MIBI SPECT/CT and ultrasonography in the detection of ectopic parathyroid glands.

A retrospective review was performed on patients with secondary hyperparathyroidism in the outpatient or inpatient department of China-Japan Friendship Hospital from July 2013 to July 2018. Of 358 patients who underwent ^99mTc-MIBI SPECT/CT and ultrasound examinations, 38 had ectopic parathyroid glands. The clinical data of the patients were collected to analyze the distribution characteristics of ectopic parathyroid glands and compare the detection of ectopic parathyroid glands by ^99mTc-MIBI SPECT/CT and ultrasound.

Among the 358 patients, 38 cases of ectopic parathyroid glands were detected, with a detection rate of 10.61%. The distribution of ectopic parathyroid glands is as follows: the anterior mediastinum and thymus (25, 65.8%), the lower inferior lobe of the thyroid gland (2, 5.3%), the posterior cricoid cartilage (1, 2.6%), the lateral middle lobe of the thyroid gland (1, 2.6%), the supraclavicular fossa (1, 2.6%), the carotid sheath (1, 2.6%), the posterior superior sternocleidomastoid (1, 2.6%), the submandibular gland (1, 2.6%), the piriform fossa (1, 2.6%), the greater horn of the hyoid bone (1, 2.6%), the tracheoesophageal sulcus (2, 5.3%), the lateral central thyroid gland (1, 2.6%), and the subclavian artery (1, 2.6%). For the 38 cases of ectopic parathyroid glands found by SPECT/CT, only 13 (34.2%) were found by ultrasound, of which 4 (16.0%) were located in the anterior mediastinum and thymus (4/25, 16.0%) and 9 (69.2%) were located in other sites, suggesting that the efficiency of ultrasonography in the detection of ectopic parathyroid glands in deeper locations (anterior mediastinum and thymic gland) was low. The 38 patients underwent a total of 60 surgical operations (including 46 cases of general surgery, 7 cases of thoracoscopic surgery, and 7 cases of ultrasonic-guided microwave thermal ablation), and there were 10 patients who did not remove their ectopic parathyroid glands and needed to be operated again. All the unremoved parathyroid glands were ectopic in the thorax.

The high incidence of ectopic parathyroid is still the main reason for the failure of parathyroid gland surgery. ^99mTc-MIBI SPECT/CT is an ideal examination method for finding ectopic parathyroid glands. For the detection of mediastinal or thymic ectopic parathyroid glands, ^99mTc-MIBI SPECT/CT is superior to ultrasound.