Murat Haluk ÖZKUL, Melek UYAR, Özlem BAYRAM, Burak DİKMEN

Paratiroid adenomlarda paratiroid sintigrafi ve minimal invaziv cerrahi

Amaç: Bu çalışmada, paratiroid patolojileri lokalize etmede tek foton emisyon bilgisayarlı tomografi ile teknesyum 99m sestamibi sintigrafinin diyagnostik kapasitesi tanımlandı.Hastalar ve Yöntemler: Ocak 2013-Aralık 2013 tarihleri arasında Haseki Eğitim ve Araştırma Hastanesi Kulak-Burun-Boğaz Kliniğinde primer hiperparatiroidizm nedeniyle minimal invaziv paratiroidektomi yapılan 13 hastanın 4 erkek, 9 kadın; ort. yaş 49.23 yıl; dağılım 27-63 yıl verileri retrospektif olarak incelendi. İki hasta eksik belge nedeniyle çalışma dışı bırakıldı.Bulgular: Ameliyat öncesi ortalama paratiroid hormonu ve kalsiyum seviyeleri sırasıyla 284.36 134-1083 pg/mL ve 11.9 10.7-13.5 mg/dL idi. Ameliyat sırası paratiroid hormonunun ameliyat öncesi seviyenin %50 altına düşmesi veya dondurulmuş kesit incelemesinin hiperselüler bez veya adenoma göstermesi halinde ameliyat yeterli kabul edildi. Tüm hastalarda, sadece sestamibi sintigrafi sonuçları ile fokal eksplorasyon sonuçları uyumluydu. Sestamibi ile tek adenoma tespit edilen 10 hastada minimal invaziv paratiroidektomi yoluyla fokal eksplorasyon ve paratiroid adenoma eksizyonu başarıyla yapıldı.Sonuç: Tek foton emisyon bilgisayarlı tomografi ile teknesyum 99m sestamibi sintigrafi ve dondurulmuş kesit analizi diğer ameliyat öncesi lokalizasyon tekniklerine göre daha anlamlı bilgiler sağlayıp daha avantajlı olabilir

Anahtar Kelimeler:

Paratiroidektomi, primer hiperparatiroidizm, teknesyum 99m sestamibi

Parathyroid scintigraphy and minimal invasive surgery in parathyroid adenomas

Objectives: This study aims to identify the diagnostic capacity of the technetium 99m sestamibi scintigraphy with single photon emission computed tomography for localizing parathyroid pathologies. Patients and Methods: Data of 13 patients 4 males, 9 females; mean age 49.23 years; range 27 to 63 years who had minimally invasive parathyroidectomy due to primary hyperparathyroidism at the Haseki Training and Research Hospital Ear-Nose-Throat clinic between January 2013 and December 2013 were retrospectively analyzed. Two patients were excluded due to incomplete documentation. Results: Mean preoperative parathyroid hormone and calcium levels were 284.36 134-1,083 pg/mL and 11.9 10.7-13.5 mg/dL , respectively. The operation was deemed adequate if intraoperative parathyroid hormone dropped by 50% from the preoperative level or frozen section analysis showed hypercellular gland or adenoma. Only sestamibi scintigraphy results were consistent with focal exploration findings in all patients. Focal exploration and parathyroid adenoma excision via minimally invasive parathyroidectomy were successfully carried out in 10 patients with single adenoma confirmed by sestamibi. Conclusion: Technetium 99m sestamibi scintigraphy with single photon emission computed tomography and frozen section analysis may provide more meaningful information and be more advantageous compared to other preoperative localization techniques.

Keywords:

Parathyroidectomy, primary hyperparathyroidism, technetium 99m sestamibi,

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