[术前可视化在原发性甲状旁腺功能亢进症手术选择中的作用]。

Q4 Medicine
D M Buzanakov, I V Sleptsov, A A Semenov, R A Chernikov, K Y Novokshonov, Yu V Karelina, N I Timofeeva, L G Yanevskaya, T A Dzhumatov
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引用次数: 0

摘要

背景:准确定位异常的甲状旁腺对于原发性甲状旁腺功能亢进症(PHPT)手术的成功非常重要。虽然大量患者可通过聚焦甲状旁腺切除术获得成功治疗,但仍有相当比例的原发性甲状旁腺功能亢进症(PHPT)持续存在,这主要是因为多腺体疾病(MGD)未被发现。研究目的:该研究旨在评估术前可视化数据对原发性甲状旁腺功能亢进症(PHPT)患者手术规划的意义:研究于2017-2018年在SPBU医院进行。研究纳入了 810 名接受 PHPT 初级手术的患者。对术前影像学结果进行调查,并计算多变量逻辑回归,以评估术前数据的预测价值。比较了术前数据结果不同的患者中疾病持续存在的病例比率和MGD病例比率:结果:年龄、性别、体重指数、术前 US、MIBI 和 4D CT 阴性结果与多腺疾病的高风险无独立关联。术前可视化检查次数越多,多腺疾病持续存在的风险越高。37%的多腺疾病病例在术前未被发现。有7个病例在双侧颈部探查时才发现先前未曾怀疑的第二腺瘤:结论:任何术前可视化方式的组合都无法可靠地排除多发性腺瘤。手术治疗的效果与术前检查次数的多少无关。双侧颈部探查可降低持续性甲状旁腺功能亢进的发生率,提高多腺疾病的识别率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Role of preoperative visualization in the choice of surgery for primary hyperparathyroidism].

Background: Precise localization of abnormal parathyroid glands is important for a successful surgery for primary hyperparathyroidism (PHPT). While a large number of patients can be successfully treated with the focused parathyroidectomy, there is a considerable rate of the persistent PHPT mostly because of undetected multiglandular disease (MGD).

Aim: The aim of the study was to evaluate the meaning of preoperative visualization data for planning the surgery for patients with PHPT.

Materials and methods: The study was conducted at SPBU Hospital in 2017-2018. 810 patients who underwent a primary surgery for PHPT were included in the study. Preoperative imaging results were investigated and multivariative logistic regressions were calculated to assess the predictive values of preoperative data. The rate of cases with persistent disease and cases with MGD were compared between patients with different results of preoperative data.

Results: Age, sex, body mass index, negative results of preoperative US, MIBI and 4D CT were not independently associated with the higher risk of multiglandular disease. The larger number of performed preoperative visualization studies were associated with the higher risk of persistence. 37% cases of MGD were not identified preoperatively. There were 7 cases with previously unsuspected second adenomas found only due to bilateral neck exploration.

Conclusion: Any combination of preoperative visualization modalities was not able to rule out the MGD reliably. Efficacy of surgical treatment was not associated with the higher number of preoperative studies. Bilateral neck exploration may decrease the rate of the persistent hyperparathyroidism improving the identification of multiglandular disease.

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来源期刊
Problemy endokrinologii
Problemy endokrinologii Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
1.40
自引率
0.00%
发文量
59
期刊介绍: Since 1955 the “Problems of Endocrinology” (or “Problemy Endocrinologii”) Journal publishes timely articles, balancing both clinical and experimental research, case reports, reviews and lectures on pressing problems of endocrinology. The Journal is aimed to the most topical issues of endocrinology: to chemical structure, biosynthesis and metabolism of hormones, the mechanism of their action at cellular and molecular level; pathogenesis and to clinic of the endocrine diseases, new methods of their diagnostics and treatment. The Journal: features original national and foreign research articles, reflecting world endocrinology development; issues thematic editions on specific areas; publishes chronicle of major international congress sessions and workshops on endocrinology, as well as state-of-the-art guidelines; is intended for scientists, endocrinologists diabetologists and specialists of allied trade, general practitioners, family physicians and pediatrics.
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