27例甲状旁腺占位病变的临床分析

Clinical analysis of 27 cases of parathyroid neoplasms

目的探讨甲状旁腺占位病变的临床表现、诊断和治疗方法。方法回顾性分析27例甲状旁腺占位病变患者临床资料。结果本组男12例,女15例,男女比例为1∶1.25;平均年龄(47±11.3)岁。其中甲状旁腺腺瘤12例,甲状旁腺癌5例,甲状旁腺囊肿10例。临床表现有颈部肿物、骨关节疼痛、骨质疏松、脊柱侧弯、局部骨肿物、泌尿系结石、恶心呕吐、口渴乏力、多尿多饮、声嘶、胸闷咳嗽等。术前定性检查为血清钙离子及血甲状旁腺素检测。术前定位检查为B超、99mTc-MIBI、CT、MRI。甲状旁腺腺瘤12例(1例多发性腺瘤)、甲状旁腺囊肿10例均经手术治疗,症状缓解,随访未见复发。甲状旁腺癌5例均经手术治疗,3例分别于随诊9、13、14个月后死亡,1例随诊2年3个月无瘤生存,1例随诊1年6个月无瘤生存。结论血清钙离子及血甲状旁腺素检测结合B超、99mTcMIBI、CT、MRI有助于甲状旁腺占位的诊断。手术为甲状旁腺占位病变的治疗手段。甲状旁腺癌的首次手术应为根治性手术,如有颈淋巴结肿大须行颈淋巴结清扫术,单纯肿瘤切除效果不佳。

Objective To explore the symptoms, diagnosis and treatment of parathyroid neoplasms. Methods Clinical data of 27 cases of parathyroid neoplasms were retrospectively analyzed. Results The number of males and females were 12 and 15, with females ： males ratio being 1： 1.25. Their mean age was 47 ± 11.3 years. There were 12 cases of parathyroid adenoma, 5 cases of parathyroid cancer, 10 cases of parathyroid cyst in this study. The symptoms were as follows： neck lump, renal calculi, nephrocalcinosis, renal dysfunction, osteoporosis, osteitis fibrosa cystica,arthrosis pain, scoliosis, nausea, vomiting, fatigue, thirst, diuresis, voice hoarseness, cough. Serum calciumion level and serum parathyroid hormone（PTH） level were examined qualitatively before operation. Ultrasonography, ECT/^99m Tc-MIBI, CT, MRI were used in diagnosing and locating parathyroid neoplasm before operation. Twelve cases of parathyroid adenoma ,5 cases of parathyroid cancer and 10 cases of parathyroid cyst were treated with operation. Patients with parathyroid adenoma and cyst got good results. Three cases of parathyroid cancer died 9,13 and 14 months after operation. Two cases of parathyroid cancer survived with no recurrence during follow up for 27 months and 18 months after operation. Conclusion Examination of serum calciumion level and serum PTH level together with ultrasonography, ECT/^99m Tc-MIBI, CT, MRI is helpful to diagnose parathyroid neoplasm. Operation is primary treatment. An enbloc resection should be done for the parathyroid cancer and suspicious lymph node should be removed. Simple resection of tumor is not effective.