USE OF INTEROPERATIVE QUICK PARATHYROID HORMONE ASSAY

甲状旁腺静脉取样仍然是甲状旁腺手术失败患者最精确的定位技术，但它需要大量的血管造影经验以及长时间的导管操作来取样引流颈部和纵隔的多条小静脉。在手术过程中了解甲状旁腺激素（PTH）梯度的存在将使血管造影师能够专注于特定区域，可能获得更详细的样本，并在早期样本中出现显著梯度时缩短手术时间。该方案不会提高采样的准确性，但会缩短程序，减少对患者和介入放射科医生的辐射暴露，并通过更集中的采样实现更精确的定位。我们计划使用最初由Nichols？术中用于通知外科医生当所有异常甲状旁腺组织已被切除。然而，由于我们需要在线检测多个甲状旁腺激素样本，而且这种检测方法并不便宜，因此我们一直在与Nichols合作开发一种更敏感、更便宜的快速甲状旁腺激素检测方法。这是最近才完成的，尼科尔斯？实验室已同意为我们的调查免费提供检测试剂盒。虽然到目前为止还没有患者累积到该方案，甲状旁腺静脉取样期间的在线PTH检测将是隐匿性甲状旁腺腺瘤患者工作的有用临床补充，我们计划继续该方案。

Parathyroid venous sampling remains the most precise localization technique for patients with failed parathyroid surgery but it requires considerable experience on the part of the angiographer as well as prolonged catheter manipulation to sample the multiple small veins draining the neck and mediastinum. Knowledge of the presence of parathyroid hormone (PTH) gradients during the procedure would enable the angiographer to focus on a specific area, perhaps obtaining more detailed samples and to shorten the procedure when significant gradients occur in the early samples. This protocol will not increase the accuracy of sampling but will shorten the procedure, reduce radiation exposure to the patient and to the interventional radiologist and allow more precise localization by more focused sampling.We plan to use the quick PTH assay originally developed by Nichols? Lab for intraoperative use to inform the surgeon when all abnormal parathyroid tissue has been resected. However as we would be assaying multiple PTH samples on line and the assay is not cheap, we have been collaborating with Nichols to develop a more sensitive, less expensive rapid PTH assay. This has recently been accomplished and Nichols? Lab has agreed to provide assay kits at cost for our investigation. Although no patients have been accrued to this protocol thus far, on-line PTH assays during parathyroid venous sampling will be a useful clinical addition to the work-up of patients with occult parathyroid adenomas and we plan to continue this protocol.