کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
4294432 1612337 2006 6 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Intraoperative Parathyroid Hormone Measurement During Minimally Invasive Parathyroidectomy: Does it “Value-Add” to Decision-Making?
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی عمل جراحی
پیش نمایش صفحه اول مقاله
Intraoperative Parathyroid Hormone Measurement During Minimally Invasive Parathyroidectomy: Does it “Value-Add” to Decision-Making?
چکیده انگلیسی

BackgroundRoutine use of intraoperative parathyroid hormone levels (IOPTH) during minimally invasive parathyroidectomy (MIP) has been challenged simply because the test works best when needed least, ie, once a solitary adenoma has been resected, and is less accurate with multiple gland disease. It has also been shown not to be cost-effective. The aim of this study was to determine if IOPTH “value-added” to decision-making during MIP.Study designThe study group comprised 100 consecutive patients with sporadic hyperparathyroidism and an unequivocally positive sestamibi scan who were undergoing MIP in our unit from June 2004 until October 2005, from whom blood was collected for parathyroid hormone measurement preoperatively, preexcision, and at 10 and 30 minutes postremoval. No action was taken on the results of the test.ResultsNinety-eight patients were cured by MIP alone. Two patients had persistent hyperparathyroidism, one of whom was cured with subsequent open reexploration and removal of a second adenoma, and the other remains hypercalcemic despite additional open neck exploration. IOPTH in both patients failed to fall in retrospect, only the first would have been cured by conversion at the time of operation. The value-added accuracy of IOPTH was really only 1%. In an additional nine patients, IOPTH at 10 minutes had failed to fall by > 50% from the highest level, those patients (9%) would have been subjected to an unnecessary conversion on the basis of a false-negative result.ConclusionsIOPTH does not substantially value-add to decision-making during MIP. Most patients will be cured with appropriate selection for MIP based on preoperative localization studies.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Journal of the American College of Surgeons - Volume 203, Issue 1, July 2006, Pages 1–6
نویسندگان
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