【摘要】目的探讨锝(99Tcm)甲氧异腈[technetium(99Tcm) sestamibi，99Tcm-MIBI]单光子发射型计算机断层显像/计算机体层摄影(single-photon emission computed tomography/computed tomography，SPECT/CT)双时相断层融合显像在进行再次手术治疗的继发性甲状旁腺功能亢进患者术前定位中的临床价值。方法回顾性分析2016 年1 月～2019 年3 月19 例进行再次手术治疗的继发性甲状旁腺功能亢进患者的临床资料，所有患者在进行再次甲状旁腺切除术前均行99Tcm-MIBI SPECT/CT 双时相断层融合显像，并与颈部超声结果进行对比，以手术病理为“金标准”，比较99Tcm-MIBI SPECT/CT 双时相断层融合显像及超声对甲状旁腺病灶的诊断效能。结果99Tcm-MIBI SPECT/CT 双时相断层融合显像及颈部超声对所有甲状旁腺病灶和异位甲状旁腺病灶检出的灵敏度分别为95.2%、52.3%和90.9%、18.2%，两者的差异有统计学意义(P 值分别为0.004、0.008)。99Tcm-MIBI SPECT/CT 双时相断层融合显像对所有甲状旁腺病灶和异位甲状旁腺病灶检出的准确性分别为71.4%、83.3%，均高于及颈部超声的准确性34.3%、18.2%。结论99Tcm-MIBI SPECT/CT 双时相断层融合显像对再次手术的继发性甲状旁腺功能亢进患者所有甲状旁腺病灶检出的灵敏度和准确性高于超声、尤其对于异位甲状旁腺病灶检出的灵敏度和准确性更高，在再次手术继发性甲状旁腺功能亢进症患者的术前定位中发挥着重要的临床价值。

【Abstract】Objective To evaluate the value of 99Tcm-MIBI SPECT/CT dual-phase tomography in rEoperation therapy of secondary hyperparathyroidism. Methods A total of 19 patients with secondary hyperparathyroidism who underwent rEoperation from Jan. 2016 to Mar. 2019 were retrospectively analyzed. All patients underwent 99Tcm-MIBI SPECT/CT dual- phase tomography before rEoperation, and the results were compared with those of neck ultrasonography. The diagnostic efficacy of 99Tcm-MIBI SPECT/CT dualphase tomography and ultrasonography for parathyroid lesions was compared with the "golden standard", pathological findings of the surgical samples. Results The sensitivities of 99Tcm-MIBI SPECT/CT dualphase tomography and neck ultrasonography were 95.2% and 52.3% respectively for the diagnosis of secondary hyperparathyroidism (P=0.004) and were 90.9% and 18.2% respectively for the diagnosis of ectopic parathyroid gland (P=0.008). The accuracies of 99Tcm-MIBI SPECT/CT dual-phase tomography in the diagnosis of secondary hyperparathyroidism and ectopic parathyroid gland were 71.4% and 83.3%respectively, higher than those of neck ultrasonography (34.3% and 18.2% respectively). Conclusions 99Tcm-MIBI SPECT/CT dual-phase tomography is more sensitive than ultrasonography in detection of parathyroids, especially in detection of ectopic parathyroids, in rEoperation therapy of secondary hyperparathyroidism. This method is clinically valuable for the localization of parathyroids in secondary hyperparathyroidism patients before rEoperation.