21例甲状旁腺腺瘤的临床分析

Diagnosis and surgical treatment of parathyroid adenoma:a clinical analysis of 21 cases

目的探讨甲状旁腺腺瘤(PTA)患者的诊断和外科治疗。方法回顾性分析我科1992年3月—2007年6月经手术确诊的21例PTA患者的临床资料。结果21例患者中男7例,女14例,中位病程为16个月。有骨骼系统临床表现12例,泌尿系统结石表现11例,消化系统表现3例,兼有多系统表现5例。所有患者的血清钙和甲状旁腺素水平明显升高,19例患者有低磷血症和血碱性磷酸酶升高。所有患者均行手术治疗,切除PTA 23枚,术后均出现一过性低钙血症,术后1周～3个月恢复至正常水平。彩色多普勒超声检查的敏感性和特异性分别为100%和86%。术后随访3～180个月,无复发。结论慢性骨病、反复发作的泌尿系结石应作为PTA的疑诊对象,血钙和血清甲状旁腺素测定是可靠的定性诊断手段,彩色多普勒超声检查是较好的定位检查。手术是治疗该病的有效手段。

Objective To summarize out experience in diagnosis and surgical treatment of parathyroid adenoma （PTA）. Methods The clinical data of 21 patients with PTA, who were admitted in our department from Mar 1992 to Jun 2007, were retrospectively reviewed. Results There were 7 males and 14 females in this group, with an average disease course of 6 months. Twelve cases had symptoms and signs of skeleton system, 11 had nephrolithiasis, 3 had digestive symptoms, and 5 had multi system symptoms. All the cases had hypercalcemia and obviously increased serum parathyroid hormone （PTH）; 19 had hypophosphatemia and increased alhaline phosphatase level. All patients received operations and 23 PTA masses were removed. Transient postoperational hypocalcemia was found in all patients and the serum calcium recovered to normal level within 1 weeks to 3 months after operation. Ultrasonography could better localize the adenomas, with a sensitivity of 100% and a specificity of 86%. No recurrence was noticed during a follow up of 3-- 180 months. Conclusion PTA should be considered in patients with chronic bone diseases, repeatedly recurrent nephrolithiasis, peptic ulcer disease or pancreatitis. Serum calcium and phosphate assay are reliable method for diagnosis of PTA. Ultrasonography is a better method for location examination. Adenorectomy is effective for treatment of PTA. （Shanghai Med J, 2008, 31 ： 312-313）