甲状旁腺腺瘤42例临床分析

Clinical analysis of parathyroid adenoma(42 cases)

目的:探讨甲状旁腺腺瘤(parathyroidadenoma,PTA)的诊断和外科治疗。方法:回顾性分析甲状旁腺腺瘤42例资料。结果:42例中,平均病程为(3.56±2.95)年;全部42例血钙和血清PTH均高于正常;定位检查方法的敏感性和阳性预测值分别为:Doppler彩超:96.4%和93.1%,99Tmc-MIBI:100%和96.8%;在Doppler彩超和99Tmc-MIBI结果吻合的27例中,单侧甲状旁腺探查组手术时间显著低于双侧探查组(15例,87.5min/12例,115.5min,P<0.05)。结论:对慢性骨病、反复发作泌尿系结石、溃疡病及胰腺炎患者,应作为PTA的疑诊对象,血钙检查作为筛查手段应列为常规;血钙和血清PTH测定是可靠的定性诊断手段;Doppler彩超和99Tmc-MIBI相结合可获得准确的定位诊断;定位明确的腺瘤结合术中冰冻病理检查行单侧甲状旁腺探查是可行的。

Objective： To summarize the experience in diagnosis and surgical treatment of parathyroid adenoma （PTA）. Methods： The clinical and pathological data of 42 cases were reviewed from Jan. 1995 to Jan. 2005 in our hospital. Results： The average course of the 42 cases is 3.56±2.95 years. The serum calcium and PTH level elevated in all the 42 cases. The sensitivity and positive predict value of locazation methods were： ultrasonography： 96.4%and 93.1%, ^99Tc^m-MIBI scintigraphy： 100%and 96.8%. In the 27 cases ultrasonography results being concordant with ^99Tc^m-MIBI scintigraphy, the average operating room time of the unilateral neck exploration group （15 cases） was 87.5 minutes, showed significant low than the bilateral exploration group （12cases, 115.Sminutes, P 〈 0.05）. Conclusion： Patients with chronic bone diseases,nephrolithiasis,peptic ulcer diseases and pancreatitis should be regarded as suspectable cases of PTA, the serum calcium screening should be performed as routine procedure. Serum calcium and PTH assays are both reliable methods for the diagnosis of PTA. Ultrasonography and ^99Tc^m-MIBI scintigraphy are sufficient for locating adenomas. Accompanied by intraoperative pathological examination, unilateral neck exploration is acceptable approach for the patients with definitive preoperative lesions localization.