甲状旁腺腺瘤致原发性甲状旁腺功能亢进症的小切口手术治疗（附28例临床分析）

Minimal access parathyroidectomy for primary hyperparathyroidism caused by parathyroid adenoma：report of 28 cases

目的总结甲状旁腺腺瘤致原发性甲状旁腺功能亢进症（PHPT）小切口手术治疗的临床经验。方法回顾我院2000年1月至2009年1月28例PHPT行颈部小切口手术治疗的临床资料。结果本组25例有明显临床表现；术前实验室检测均发现血钙和血甲状旁腺激素（PTH）升高；B超、^99Tc—MIBI核素扫描定位诊断准确率达100％。28例均行颈部小切口甲状旁腺腺瘤切除，为单发腺瘤，术后无并发症，随访6个月血钙降低或恢复正常，复查PTH在正常值2倍以内，无复发或持续性病例。手术治疗成功率100％，创伤小、住院时间短、耐受性好。结论对PHPT，B超、^99Tc—MIBI扫描是有效的术前定位检查；颈部小切口甲状旁腺腺瘤切除术对定位诊断明确的PHPT有很好的应用前景。

Objective To evaluate our experience of minimal access parathyroidectomy for primary hyperparathyroidism （PHPT） caused by parathyroid adenoma. Methods From Jan 2000 to Jan 2009, clinical data of 28 cases of PHPT treated by minimal access surgery were analyzed retrospectively. Results All patients except 3 had severe clinical manifestations, serum calcium and parathyroid hormonal （PTH） of all the cases were elevated. The rate of accuracy of preoperation localization by the sestamibi scan combined with ultrasound was 100%. The pathological diagnoses of all the 28 cases were uni-gland parathyroid adenoma. Within the follow-up of 6 months, no case suffered complication and recurrence, the levels of serum calcium were normal or decreased slightly, and the levels of PTH were normal or elevated slightly but no higher than 2 times of normal PTH level. Conclusions Preoperative localization is very helpful by using combination of sestamibi and ultrasound scan. Minimally invasive parathyroidectomy is a kind of improving procedure for the localized parathyroid adenoma.