原发性甲状旁腺功能亢进症的诊断和治疗(附19例报告)

DIAGNOSIS AND SURGICAL TREATMENT OF 19 PATIENTS WITH PRIMARY HYPERPARATHYROIDISM

目的 探讨原发性甲状旁腺功能亢进症的诊断和手术处理方法。方法 对本院 1981～ 1998年收治的 19例原发性甲状旁腺功能亢进症的患者的临床表现、实验室检查和术前、术中定位方法及手术治疗进行回顾性分析。结果 持重部位骨关节疼痛、多发骨折为其主要征象 ,实验室检查有血钙、血甲状旁腺激素、血碱性磷酸酶及尿钙、尿磷升高和血磷降低。X线主要表现为骨质疏松、骨质变薄。B超、CT及99mTc造影 3项结合可使术前定位准确率达 89%以上。手术中利用甲状腺胸腺韧带及甲状腺下动脉注射亚甲蓝染色可帮助寻找病变的甲状旁腺。结论 原发性甲状旁腺功能亢进症需结合临床症状及辅助检查。术前、术中的准确定位及冰冻病理的定性检查是手术成功的关键。一侧甲状旁腺中仅有 1个病变者可只行单侧探查。

Objective: To study the diagnosis and surgical treatment of primary hyperparathroidism. Methods: 19 patients with hyperparathroidism who were treated in our hospital from 1981 to 1998 were analysed retrospectively. Results: The main clinical manifestation was symmetrical pain of the supporting bones and joins, hypercalcemia, hypercalnuria, hypophosphatemia and hyperalkaline phosphatasemia, and increase of PTH in peripheral blood. X-ray examination showed ostroporosis and decalcification, accopanied with multiple fracture. The accuracy of parathyroid tumor localization was above 89% by B ultrasound CT scan and 99 mTc examination preoperation. thymo-thyroid ligment was used as guide and injectied methylene blue into the artery during opeation to search parathyroid tumor. Conclusion: The key procedure of the operation was to search for tumor of parathyroid. If one abnormal parathyroid gland and a normal gland are found on the first side of the neck, the second side shoud not be explored.