核素掃描為假陰性原發性甲狀旁腺功能亢進癥手術時機及治療策略的把握_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

王雪薇 , 張妍妍 , 韓哲 , 張歡 ,  陳光

吉林大學第一醫院甲狀腺外科（長春 130021）;

Corresponding?author：

陳光, Email: cg9293@sina.com

Keywords：

⁹⁹Tc^m-MIBI SPECT/CT 掃描; 原發性甲狀旁腺功能亢進癥; 手術時機; 治療策略

DOI：

10.7507/1007-9424.201909039

Video：

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目的結合臨床病例分析原發性甲狀旁腺功能亢進癥（PHPT）患者行 ⁹⁹锝^m-甲氧基異丁基異腈（⁹⁹Tc^m-MIBI）SPECT/CT 核素掃描結果為假陰性的原因，為在臨床工作中核素掃描結果為假陰性或與其他影像學定位結果不一致的 PHPT 患者提供把握手術時機及治療策略的思路。方法回顧性分析吉林大學第一醫院甲狀腺外科收治的 4 例核素掃描結果為假陰性的 PHPT 患者的臨床病理資料。結果 PHPT 患者甲狀旁腺病灶的大小、是否伴有出血、壞死、囊性變以及是否為惡性腫瘤伴發廣泛轉移都可導致 ⁹⁹Tc^m-MIBI SPECT/CT 呈現假陰性結果。結論 ⁹⁹Tc^m-MIBI SPECT/CT 掃描結果不能作為 PHPT 是否行手術治療的判定標準，在臨床工作中當 ⁹⁹Tc^m-MIBI SPECT/CT 結果呈現假陰性或與其他影像學定位結果不一致時，應結合患者實驗室檢查及其他影像學檢查結果綜合考慮，定位病灶，避免臨床誤診，把握好手術時機以避免遺漏多發甲狀旁腺病灶，減少不必要的雙側頸部探查，提高手術成功率。

Citation： 王雪薇, 張妍妍, 韓哲, 張歡, 陳光. 核素掃描為假陰性原發性甲狀旁腺功能亢進癥手術時機及治療策略的把握. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(7): 880-883. doi: 10.7507/1007-9424.201909039 Copy

1.	Dy BM, Richards ML, Vazquez BJ, et al. Primary hyperparathyroidism and negative Tc99 sestamibi imaging: to operate or not? Ann Surg Oncol, 2012, 19(7): 2272-2278.
2.	寧志偉, 王鷗, 徐競英, 等. 原發性甲狀旁腺功能亢進癥患者術前病變甲狀旁腺定位方法的評估. 中國醫學科學院學報, 2003, 25(3): 280-284.
3.	Melloul M, Paz A, Koren R, et al. ^99mTc-MIBI scintigraphy of parathyroid adenomas and its relation to tumour size and oxyphil cell abundance. Eur J Nucl Med, 2001, 28(2): 209-213.
4.	Bénard F, Lefebvre B, Beuvon F, et al. Rapid washout of technetium-99m-MIBI from a large parathyroid adenoma. J Nucl Med, 1995, 36(2): 241-243.
5.	Gupta Y, Ahmed R, Happerfield L, et al. P-glycoprotein expression is associated with sestamibi washout in primary hyperparathyroidism. Br J Surg, 2007, 94(12): 1491-1495.
6.	Uchida N, Yoshida M, Matsui Y, et al. A case report of a functioning mediastinal parathyroid cyst with no ^99mTc-MIBI uptake. International J Surg Open, 2018, 12: 5-8.
7.	Lussey-Lepoutre C, Trésallet C, Ghander C, et al. The role of imaging in the preoperative management of primary hyperparathyroidism: A current up-date. Médecine Nucléaire, 2018, 42(1): 49-58.
8.	Lundstroem AK, Trolle W, Soerensen CH, et al. Preoperative localization of hyperfunctioning parathyroid glands with 4D-CT. Eur Arch Otorhinolaryngol, 2016, 273(5): 1253-1259.
9.	Beheshti M, Hehenwarter L, Paymani Z, et al. ¹⁸F-Fluorocholine PET/CT in the assessment of primary hyperparathyroidism compared with ^99mTc-MIBI or ^99mTc-tetrofosmin SPECT/CT: a prospective dual-centre study in 100 patients. Eur J Nucl Med Mol Imaging, 2018, 45(10): 1762-1771.
10.	何泱, 孫立昊, 劉建民. 原發性甲狀旁腺功能亢進癥患者即使影像學定位不能確定也應手術探查治療. 中華內分泌代謝雜志, 2017, 33(11): 920-922.
11.	殷德濤, 唐藝峰. 原發性甲狀旁腺功能亢進的手術探查策略. 臨床外科雜志, 2018, 26(6): 405-407.
12.	Beyer TD, Solorzano CC, Starr F, et al. Parathyroidectomy outcomes according to operative approach. Am J Surg, 2007, 193(3): 368-372.
13.	Wang Y, Zhang X, Wang P, et al. Intraoperative parathyroid hormone monitoring in parathyroidectomy for PHPT//International Conference on Information Technology in Medicine and Education. IEEE, 2017: 214-218.

1. Dy BM, Richards ML, Vazquez BJ, et al. Primary hyperparathyroidism and negative Tc99 sestamibi imaging: to operate or not? Ann Surg Oncol, 2012, 19(7): 2272-2278.
2. 寧志偉, 王鷗, 徐競英, 等. 原發性甲狀旁腺功能亢進癥患者術前病變甲狀旁腺定位方法的評估. 中國醫學科學院學報, 2003, 25(3): 280-284.
3. Melloul M, Paz A, Koren R, et al. ^99mTc-MIBI scintigraphy of parathyroid adenomas and its relation to tumour size and oxyphil cell abundance. Eur J Nucl Med, 2001, 28(2): 209-213.
4. Bénard F, Lefebvre B, Beuvon F, et al. Rapid washout of technetium-99m-MIBI from a large parathyroid adenoma. J Nucl Med, 1995, 36(2): 241-243.
5. Gupta Y, Ahmed R, Happerfield L, et al. P-glycoprotein expression is associated with sestamibi washout in primary hyperparathyroidism. Br J Surg, 2007, 94(12): 1491-1495.
6. Uchida N, Yoshida M, Matsui Y, et al. A case report of a functioning mediastinal parathyroid cyst with no ^99mTc-MIBI uptake. International J Surg Open, 2018, 12: 5-8.
7. Lussey-Lepoutre C, Trésallet C, Ghander C, et al. The role of imaging in the preoperative management of primary hyperparathyroidism: A current up-date. Médecine Nucléaire, 2018, 42(1): 49-58.
8. Lundstroem AK, Trolle W, Soerensen CH, et al. Preoperative localization of hyperfunctioning parathyroid glands with 4D-CT. Eur Arch Otorhinolaryngol, 2016, 273(5): 1253-1259.
9. Beheshti M, Hehenwarter L, Paymani Z, et al. ¹⁸F-Fluorocholine PET/CT in the assessment of primary hyperparathyroidism compared with ^99mTc-MIBI or ^99mTc-tetrofosmin SPECT/CT: a prospective dual-centre study in 100 patients. Eur J Nucl Med Mol Imaging, 2018, 45(10): 1762-1771.
10. 何泱, 孫立昊, 劉建民. 原發性甲狀旁腺功能亢進癥患者即使影像學定位不能確定也應手術探查治療. 中華內分泌代謝雜志, 2017, 33(11): 920-922.
11. 殷德濤, 唐藝峰. 原發性甲狀旁腺功能亢進的手術探查策略. 臨床外科雜志, 2018, 26(6): 405-407.
12. Beyer TD, Solorzano CC, Starr F, et al. Parathyroidectomy outcomes according to operative approach. Am J Surg, 2007, 193(3): 368-372.
13. Wang Y, Zhang X, Wang P, et al. Intraoperative parathyroid hormone monitoring in parathyroidectomy for PHPT//International Conference on Information Technology in Medicine and Education. IEEE, 2017: 214-218.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

核素掃描為假陰性原發性甲狀旁腺功能亢進癥手術時機及治療策略的把握

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