53例原发性甲状旁腺功能亢进症临床分析

The clinical analysis of 53 cases of primary hyperparathyroidism

目的探讨原发性甲状旁腺功能亢进症(PHPT)的临床变迁及诊治方法.方法回顾性分析我院27年来收治的5 3例PHPT的临床资料.结果53例PHPT均经手术、病理证实.发病以20～50岁为多,女性明显多于男性,临床表现多样化,病程迁延,误诊率高.全组均表现为不同程度骨病变,其中泌尿系结石加骨病变11例(20.8%).51例(96.2%)血清钙升高,48例(90.6%)PTH检查均增高.1991年后术前联合B超、CT扫描及甲状旁腺核素扫描,术前定位诊断准确.手术方式以直接甲状旁腺腺瘤切除术为主,占86.7%,一次手术治愈率97.4%.术后随访10个月～10余年,除15例严重骨畸形改善不明显外,其他症状及体征均不同程度缓解,化验指标恢复正常,无永久性甲旁减或喉返神经损伤等并发症.结论对PHPT早期诊断,早期进行有效的病灶切除治疗,可减少严重骨病变的发生,减少致残率,术前影像定位检查的联合使用,综合判断,能够提高定位诊断的准确性.

Objective To investigate the different clinical behavior and the diagnosis and trearment of primary hyperparathyroidism （ PHPT ） . Methods Clinical data of 53 patients with PHPT treated in Beijing Jishuitan Hospital from May 1977 to April 2004 were collected and analyzed. Results 53 patients with PHPT were confirmed by operation and pathology. The majority of the patients were aged 20 - 50 years. There were more female than male patients. There were various clinical manifestations, and the duration of illness was protracted. Many cases were misdiagnosed, There were bone pathologic changes of varying extent in all patients, stones in urinary system plus bone pathology in 11 cases, serum level of calcium was raised in 51 patients （ 96. 2 % ） and parathyroid hormone （ PTH ） was elevated in all examined 48 cases. Ultrasound, MIBI and CT were done before operation after 1991 , and accurate preoperative localization diagnosis was obtained. Minimally invasive parathyroidectomy （ MIP ） was successfully completed in 39 of 45 cases, and the primary operation cure rate was 97. 4%. At postoperative follow-up of 10 months to 10 years, with the exception of 15 cases of severe bone deformity that had no obvious improvement, the other symptoms and signs were all relieved to varying extents, the laboratory markers returned to normal, and there was no permanent hypoparathyroidism or recurrent nerve injury or other complications. Conclusions Early diagnosis of PHPT and effective early treatment by surgical removal of the pathologic lesion can alleviate the occurrence of severe bone changes and deformity. The preoperative combined use of imaging localization technique and overall assessment can improve the accuracy of diagnostic localization of the lesion.