原发性甲状旁腺功能亢进症的诊断研究

Diagnosis of primary hyperparathyroidism

目的:探讨原发性甲状旁腺功能亢进症(PHPT)临床症状的变迁及其诊断方法。方法:回顾分析我院2000年至2005年间收治的31例PHPT患者的临床资料。结果:PHPT发病年龄多见于50～80岁,女性明显多于男性,临床表现多样,病程迁延,误诊率高。31例中表现为不同程度骨骼病变者17例(54.8%),泌尿系结石者14例(45.2%)。30例(96.8%)血清钙升高;28例行甲状旁腺素(PTH)检查均增高。本组患者结合超声、99mTc-MIBI和CT等检查后,除1例未行手术外,其余30例均经手术及病理证实,结合术后病理,术前定位准确率达100%。手术方式以直接甲状旁腺腺瘤切除术为主,占70%。术后患者症状改善,血清钙、PTH值明显下降。结论:对PHPT早期诊断,早期行有效的病灶切除治疗,可减少严重骨病变的发生,术前功能诊断和影像学定位检查联合,可显著提高定位诊断的准确度。

Objective To investigate the different clinical behavior and the diagnosis of primary hyperparathyroidism （PHPT）. Methods The clinical data of 31 patients with PHPT treated in the Sixth People＇s Hospital, Shanghai Jiaotong University from 2000 to 2005 were collected and analyzed. Results Thirty patients with PHPT were confirmed by operation and pathology. The majority of the patients were aged 50-80 years. There were more females than males. The patients had various clinical manifestations with protracted duration and high rate of misdiagnosis. Seventeen patients （54.8%） had bone pathologic changes with varying extent, and 14 patients （45.2%） had stones in urinary system. Serum calcium level rose in 30 patients （96.8%） and parathyroid hormone （PTH） was elevated in 28 cases. Ultrasound, ^99mTc-MIBI and CT were performed before the operation with the preoperative localization accuracy of 100%. Minimally invasive parathyroidectomy （MIP） was successfully completed in 21 cases. After the operation, the serum levels of calcium and PTH came down. Conclusions Early diagnosis of PHPT and effective early treatment by surgical removal of the pathologic lesions could alleviate the occurrence of severe bone changes and deformity. Preoperative combined use of the imaging localization techniques and overall assessment could improve the diagnostic accuracy of lesion localization.