原发性甲状旁腺功能亢进症44例的诊断与外科治疗

Diagnosis and surgical treatment of primary hyperparathyroidism in 44 patients

目的总结原发性甲状旁腺功能亢进的诊断与外科治疗经验。方法回顾性分析1987年至2007年经手术及病理证实的44例原发性甲状旁腺功能亢进的临床资料。结果生化检查44例均定性为甲状旁腺功能亢进症。44例原发性甲状旁腺功能亢进症的定位诊断，经B超、CT、^99mTc—MIBI、MRI检查的阳性准确率分别为88．6％、86．4％、94．1％、87．5％，其中发现异位甲状旁腺腺瘤2例、前纵隔甲状旁腺腺瘤2例、甲状旁腺腺癌3例、甲状旁腺增生2例。特别是应用B超、CT、^99mTc—MIBI相结合的诊断准确率最高为95．5％。44例均行外科手术治疗，其中甲状旁腺腺瘤切除35例；异位甲状旁腺腺瘤2例，按部位切除腺瘤；前纵隔甲状旁腺腺瘤2例，按开胸手术切除；甲状旁腺增生2例按经典BNE方法切除病变腺体；甲状旁腺癌3例，行联合整块（En bloc）切除根治术。44例术后效果佳，但手术后均发生不同程度的低钙血症，应用钙剂后症状缓解。结论定性诊断主要依据血钙和甲状旁腺素的同步升高，术前定位诊断是手术成功的关键，一旦确诊就应积极手术治疗，效果良好。

Objective To summarize the experience in diagnosis and surgical treatment of primary hyperparathyroidism, nothods Clinical data of 44 patients with primary hyperparathyroidism were analyzed retrospectively from 1987 - 2007. Results Forty - four patients were diagnosed qualitatively as primary hyperparathyroidism by biochemical examination. B ultrasound, CT,^99mTc -MIBI, and MRI were important methods to localization diagnosis, and their accurate rate was 88. 6%, 86.4%, 94.1%, and 87.5% respectively. Of 44 patients,there were 2 cases of ectopic parathyroid adenoma,2 cases of parathyroid adenoma in anterior mediastinum,3 cases of parathyroid carcinoma, and 2 cases of parathyroid hyperplasia. Accurate rate of B uhrasound,CT and 99ZTc - MIBI together was 95.5%. Forty - four patients were surgically treated, including adenoma resection in 35 patients, ectopic parathyroid adenoma resection in 2 patients, anterior mediastinum parathyroid adenoma resection in 2 patients, classic BNE method resection in 2 patients, and en bloc resection in 3 patients with parathyroid carcinoma. The surgical outcome was satisfactory. Varying degrees of hypocalcemia occurred after operation in all patients. Hypocal- cemia could be retrieved after administration of calcium. Conclusion Simultaneous increase of serum calcium and parathyroid hormone is main evidence of qualitative diagnosis. Localization diagnosis is the key to surgical treatment. Surgical treatment should be done as soon as possible once diagnosis is made.