Background: Primary hyperparathyroidism (PHPT) is caused by excessive parathormone secretion from one or more parathyroid glands. The primary treatment for PHPT is surgery. Due to anatomical variations in the parathyroid glands, preoperative localization, surgical approaches, and success rates can vary. With the development of advanced imaging techniques and the introduction of intraoperative intact PTH (i-PTH) measurement, traditional extended surgical approaches have increasingly been replaced by focused surgeries.

Objective: Intraoperative i-PTH measurement has been applied by different surgeons using various criteria. This study aims to evaluate the effectiveness of intraoperative i-PTH measurement in improving surgical success, particularly in cases with inconclusive preoperative imaging results.

Methods: Between January 2010 and September 2020, 203 adult patients who underwent surgery for PHPT in our clinic were included in the study. Patients were categorized into two groups: Group A (with intraoperative i-PTH measurement) and Group B (without i-PTH measurement). Persistent hyperparathyroidism was defined as elevated calcium levels occurring shortly after surgery, whereas recurrence was defined as calcium elevation after the 6th postoperative month. The absence of recurrence or persistent hypercalcemia was considered an indicator of surgical success.

Results: The mean age of the patients was 54.6 ± 12.7 years. Of the 203 patients, 40 (19.7%) were male and 163 (80.3%) were female. No correlation was found between recurrence or persistence and patient age. The overall success rate was 93.6%. Surgical success was achieved in 97.8% of patients in Group A and 90% in Group B, indicating a statistically significant difference between the groups (p = 0.023).

Conclusion: Intraoperative i-PTH measurement significantly increases the success rate of PHPT surgery, reducing the incidence of recurrent or persistent cases and the need for secondary operations. Consequently, it helps prevent complications associated with reoperations. These findings highlight the pivotal role of intraoperative i-PTH monitoring in optimizing surgical outcomes, especially in complex PHPT cases.

Keywords: Intraoperative parathyroid hormone (i-PTH); Parathyroidectomy; Persistent; Primary hyperparathyroidism (PHPT); Recurrence.

© 2025. The Author(s).

背景： 原发性甲状旁腺功能亢进（PHPT）是由一个或多个甲状旁腺过度分泌甲状旁腺激素引起的。治疗 PHPT 的主要方法是手术。由于甲状旁腺的解剖变异，术前定位、手术方法和成功率会有所不同。随着先进影像技术的发展以及术中完整 PTH (i-PTH) 测量的引入，传统的扩展手术方式越来越多地被聚焦手术所取代。

目的： 术中 i-PTH 测量由不同外科医生使用不同的标准实施。本研究旨在评估术中 i-PTH 测量在提高手术成功率方面的有效性，特别是在术前影像结果不明确的情况下。

方法： 2010 年 1 月至 2020 年 9 月期间，在我们诊所接受 PHPT 手术的 203 名成年患者被纳入研究。根据是否进行术中 i-PTH 测量，将患者分为两组：A 组（有 i-PTH 测量）和 B 组（无 i-PTH 测量）。持续性甲状旁腺功能亢进定义为术后不久出现钙水平升高，而复发则定义为术后第 6 个月后的钙水平升高。没有复发或持续高钙血症被认为是一个手术成功的指标。

结果： 患者的平均年龄为 54.6 ± 12.7 岁。在这 203 名患者中，男性占 40 名（19.7%），女性占 163 名（80.3%）。未发现复发或持续与患者年龄之间存在相关性。总体成功率是 93.6%。在 A 组中有 97.8% 的患者和 B 组中 90% 的患者实现了手术成功，表明两组之间的差异具有统计学意义（p = 0.023）。

结论： 术中 i-PTH 测量显著提高了 PHPT 手术的成功率，减少了复发或持续病例的发生率和二次手术的需要。因此，它有助于预防与再次手术相关的并发症。这些发现突显了术中 i-PTH 监测在优化复杂 PHPT 患者外科治疗结果中的关键作用。

关键词： 术中甲状旁腺激素 (i-PTH)；甲状旁腺切除术；持续性；原发性甲状旁腺功能亢进（PHPT）；复发。