[Influence of quick intraoperative measurements of intact parathyroid hormone in the surgical management of primary hyperparathyroidism].
OBJECTIVE
To evaluate whether a quick parathyroid hormone assay that measures intact parathyroid hormone (iPTH) level intraoperatively has modified the surgical strategy for primary hyperparathyroidism in the Meixoeiro Hospital in Vigo (Pontevedra, Spain).


METHODS
An observational, analytic, historic cohort study was performed. Two study groups were established. In group 1 (n = 28) iPTH levels were not measured intraoperatively. In group 2 (n = 39) iPTH was measured intraoperatively. iPTH was monitored using blood samples from cannulated peripheral veins. A positive test was defined as a decrease in iPTH level of >or= 50% of the baseline preincision level at 10 minutes postexcision, even when the baseline value was outside the normal range. The dependent variables evaluated were operating time, the number of parathyroid glands visualized, the number of parathyroid glands biopsied, length of postoperative hospital stay, unilateral exploration, and the percentages of cure, persistence, and recurrence in each group.


RESULTS
Group 2 showed a statistically significant decrease in operating time (144.7 +/- 62.1 versus 178.8 +/- 57.5 minutes; p = 0.025), the number of parathyroid glands visualized (1.9 +/- 0.9 versus 2.8 +/- 1.3; p = 0.002), the number of parathyroid glands biopsied (1.5 +/- 0.9 versus 2.2 +/- 1.4; p = 0.025), and the need for bilateral exploration (30.77% versus 85.72%) in comparison with group 1. No significant differences were observed in length of postoperative hospital stay or in the percentages of cure (94.8% versus 92.85%), persistence (5.12% versus 7.14%), and recurrence (2.56% versus 3.57%).


CONCLUSIONS
In our hospital, intraoperative measurement of iPTH improved the surgical strategy of primary hyperparathyroidism and has therefore been included in our routine treatment protocol.
Nuño Vázquez-Garza
José M
JM
Servicio de Cirugía General, Hospital do Meixoeiro, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España. jomanuvaga@hotmail.com
Suso Alea
Javier
J
Fernández Marcos
Covadonga
C
Fernández Rodríguez
Elvira
E
Carreira Delgado
Manuel
M
Seoane Antelo
Jaime
J
D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000601:surgery*; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy / Q000379:methods*; D012189:Retrospective Studies; D013030:Spain; D016896:Treatment Outcome
D010281:Parathyroid Hormone