최소 침습적 수술을 위한 술중 부갑상선 호르몬 측정 알고리즘의 제안 (Feasibility of Intraoperative Parathyroid Hormone Monitoring in Minimally Invasive Surgery)

서지정보

· 발행기관 : 대한이비인후과학회
· 수록지 정보 : 대한이비인후-두경부외과학회지 / 64권 / 7호 / 491 ~ 499페이지
· 저자명 : 김수진, 윤주현, 박솔희, 고유진, 이소정, 정수연, 김한수

초록

Background and Objectives There has been a long debate on whether intraoperative parathyroidhormone (IOPTH) monitoring is mandatory or not in the excision of a single abnormalparathyroid gland. The aim of this study is to suggest a new criteron of IOPTH monitoring.
Subjects and Method We retrospectively analyzed 31 patients who underwent parathyroidectomyfrom 2005 to 2019. Patients had IOPTH not measured and those with secondary hyperparathyroidismwere excluded. IOPTH was measured preoperatively (EX00), at 10 minutes(EX10) and 20 minutes (EX20) after the excision and analyzed. We determined the surgery asa ‘successful excision of lesion (SEOUL)’ when it met the following criteria: criterion 1) thelevel of EX10 or EX20 decreased under the upper normal or under upper limit of parathyroidhormone (65 pg/mL); criterion 2) EX20 decreased below 50% of EX00 and less than 195 pg/mL (3 times the upper normal limit); criterion 3) multiglandular disease.
Results Twenty-five patients among 31 patients were included this study (M:F=8:17). Twenty-two patients were suspected of single lesion and three patients of multiple lesions on preoperativeimages (99mTc-sestamibi scan, neck CT, and PET-CT). IOPTH of EX00, EX10, andEX20 were 488.92±658.74, 121.36±134.73, and 92.44±111.55 pg/mL, respectively. Sixty-fourpercent patients (16/25) met the criterion 1. Six patients (24%) successfully excised a lesionmeeting the criterion 2. Three patients had multiglandular disease, meeting the criterion 3.
Conclusion Our new criteria suggest when we could stop the procedure. If the level ofIOPTH does not meet the SEOUL criteria, it means that there might be more lesions.

영어초록

Background and Objectives There has been a long debate on whether intraoperative parathyroidhormone (IOPTH) monitoring is mandatory or not in the excision of a single abnormalparathyroid gland. The aim of this study is to suggest a new criteron of IOPTH monitoring.
Subjects and Method We retrospectively analyzed 31 patients who underwent parathyroidectomyfrom 2005 to 2019. Patients had IOPTH not measured and those with secondary hyperparathyroidismwere excluded. IOPTH was measured preoperatively (EX00), at 10 minutes(EX10) and 20 minutes (EX20) after the excision and analyzed. We determined the surgery asa ‘successful excision of lesion (SEOUL)’ when it met the following criteria: criterion 1) thelevel of EX10 or EX20 decreased under the upper normal or under upper limit of parathyroidhormone (65 pg/mL); criterion 2) EX20 decreased below 50% of EX00 and less than 195 pg/mL (3 times the upper normal limit); criterion 3) multiglandular disease.
Results Twenty-five patients among 31 patients were included this study (M:F=8:17). Twenty-two patients were suspected of single lesion and three patients of multiple lesions on preoperativeimages (99mTc-sestamibi scan, neck CT, and PET-CT). IOPTH of EX00, EX10, andEX20 were 488.92±658.74, 121.36±134.73, and 92.44±111.55 pg/mL, respectively. Sixty-fourpercent patients (16/25) met the criterion 1. Six patients (24%) successfully excised a lesionmeeting the criterion 2. Three patients had multiglandular disease, meeting the criterion 3.
Conclusion Our new criteria suggest when we could stop the procedure. If the level ofIOPTH does not meet the SEOUL criteria, it means that there might be more lesions.

참고자료

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