Oya YILDIZ, Alper FINDIKÇIOĞLU, Dalokay KILIÇ, Neşe TORUN

Mediastinal Paratiroid Adenomlarının Tedavisinde SPECT/BT Rehberliğinde Uygulanan Minimal İnvazif Girişimler

Ektopik paratiroid dokusunun yerini saptamak ve çıkarmak %20’nin üzerinde başarısızlıkla sonuçlanabilmektedir. Tc-99m sestamibi ile yapılan tek foton emisyon bilgisayarlı tomografi/bilgisayarlı tomografi (single photon emission computed tomography/computed tomography, SPECT/CT) görüntülemesinde saptanan ve minimal invaziv cerrahi yöntemler ile tedavi edilen yedi olgu sunulmuştur. Total/subtotal paratiroidektomi operasyonu sonrası yüksek parathormon (PTH) seviyesi nedeni ile SPECT/CT uygulanan ve mediastende ektopik paratiroid saptanan olgular dahil edilmiştir. Cerrahinin başarısı preoperatif ve postoperatif PTH düzeyleri ile değerlendirildi. Beş olguya video yardımlı toraks cerrahisi (video-assisted thoracic surgery, VATS), diğer ikisine video yardımlı mediastinoskopi (video-assisted mediastinoskopi, VAM) uygulandı. Ortalama yaş 52,4±19,0 idi. Altı olgu kadın, bir olgu erkek idi. 1,5 ile 6 cm arasında değişen mediastinal adenomlar tek denemeden sonra basit girişimler ile başarılı bir şekilde tedavi edildi. Mediastinal ektopik paratiroid adenomu ameliyat öncesi tam olarak lokalize edilebilirse minimal invaziv cerrahi yöntemlerle tedavi edilebilir.

Anahtar Kelimeler:

ektopik paratiroid, parathormon, tek foton emisyon bilgisayarlı tomografi

Minimally Invasive Interventions Used with the Guidance of SPECT/CT in the Treatment of Mediastinal Parathyroid Adenomas

Locating and removing ectopic parathyroid tissue may result in more than 20% failure. Seven cases which were detected by single photon emission computed tomography/computed tomography (SPECT/CT) imaging with Tc-99m sestamibi and treated with minimally invasive surgical methods were presented. The cases that underwent SPECT/CT due to high parathormone (PTH) level after total/subtotal parathyroidectomy operation, and detected to have mediastinal ectopic parathyroid were included. The success of the surgery was assessed with preoperative and postoperative PTH levels. Video-assisted thoracic surgery (VATS) was performed on five of the cases and video-assisted mediastinoscopy (VAM) was performed on remaining two. The mean age was 52.4±19.0. There were six women and one man. Mediastinal adenomas ranging from 1.5 to 6 cm in size, were successfully treated after single attempt. If the mediastinal ectopic parathyroid adenomas are fully localized before surgery, it can be treated with minimally invasive surgical methods.

Keywords:

Ectopic parathyroid, parathormone, single photon emission computed tomography,

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