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頁籤選單縮合
題名 | The Significance of Localization Studies Before Primary Surgery for Hyperparathyroidism=副甲狀腺高能症初次手術前定位檢查之意義 |
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作者 | 李建賢; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 19:2 1986.05[民75.05] |
頁次 | 頁122-128 |
分類號 | 416.214 |
關鍵詞 | 副甲狀腺高能症; 手術前定位檢查; |
語文 | 英文(English) |
中文摘要 | 高能副甲狀腺之定位,至今仍未有絕對可靠的辦法。民國56年至73年間,本院共經驗原發性副甲狀腺高能症45例(包括腺瘤33例及過度增生12例)及次發性者7例(均為過度增生)。手術時例行兩側頸部探查,且術後追踪至少半年。手術結果與定位檢查比對並作回顧性分析。 手術前定位檢查包括:1.頸部超音波檢查;2.熱圓;3.連續食道造影;4.電腦斷層檢查;5.選擇性甲狀腺動脈造影及6.頸部觸診。結果顯示昂貴或具侵犯性之檢查;敏感度均未超過80%,而頸部超音波檢查,對於偵測副甲狀腺腺瘤之敏感性為67%,特異性為96%,正確率為94%;若合併第二線之電腦斷層檢查則各提昇為86%、94%及92%。 例行兩側頸部探查之治癒率為94.2%,未治癒者3例,均為過度增生例,因此,吾等以為:1.昂貴或具侵犯性之定位檢查,應留用於須第二次手術者;2.臨床研究者亟需努力開發出既安全又準確且經濟之定位術,以合乎例行使用;3.從事副甲狀腺手術者,應有系統性頸部探查之基本知能。 |
英文摘要 | Pre-operative location remains a problem in clinical parathyroid surgery. From 1967 to 1984, 207 parathyroid glands explored in 52 patients with hyperparathyroidism (HPT) were studied before primary operations. They were correlated retro-spectively with the operative findings. A routine bilateral neck exploration was perofrmed and patients had been folIowed up for at least six months after operations. Thirty-three adenomas were confirmed with no recurrence, in 132 explored glands of 33 patients without any recurrence. Three out of 19 patients who had parathyroid hyperplasia (including primary and secondary HPT) had recurrent hypercalcemia. The total cure rate was 94.2%. Localization studies included sonography, CT scan, thermography, cine-esophagography, selective thyroid angiography and palpation of the neck. It was found that sonogram alone had a sensitivity of 67% and specificity of 96%; these became 86% and 94%, respectively, if CT scan is combined as a second line examination. It saccuracy decreased with size of the parathyroid glands. Because of the potential risk and unsatisfactory localization rate, invasive procedures should be reserved for those who need secondary parathyroid surgery, Clinical researchers should be encouraged to look for a safe, noncostly and highly accurate localization technique. In case of a negative or false positive localization, a careful, systematic bilateral neck exploration is mandatory. |
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