原发性甲状旁腺功能亢进的诊断和治疗(附46例报道)

Diagnosis and Surgical Treatment of Primary Hyperparathyroidism:a Report of 46 Cases

目的探讨原发性甲状旁腺功能亢进(PHPT)的诊断和治疗方法。方法回顾性分析我院1990-2006年收治的46例PHPT患者的临床资料。结果46例PHPT中肾型4例,骨型24例,混合型13例,无症状5例。39例甲状旁腺腺瘤均行单侧探查术;3例甲状旁腺癌均参照甲状腺癌行根治性切除和颈部淋巴结清扫术;4例甲状旁腺增生中2例行单侧探查术,2例行双侧探查术。其中1例腺瘤并发甲状旁腺危象经内科紧急处理后急诊手术切除腺瘤,症状缓解。结论定性诊断主要依据血钙和血甲状旁腺素的同步升高。99mTc-MIBI是敏感性最高的定位诊断方法。定位明确甲状旁腺腺瘤可行单侧探查。定位不明确或异位者可在放射性核素指导下手术探查。

Objective To investigate the diagnosis and surgical treatment of primary hyperparathyroidism （PHPT）. Methods The clinical data of 46 patients with PHPT treated in the First Affiliated Hospital of China Medical University from 1990 to 2006 was retrospectively reviewed. Results 24 cases had bone pathologic changes with varying extent,4 cases had urinary stones, 13 cases had both bone pathologic changes and urinary stones, and 5 cases were asymptomatic. Unilateral neck exploration （UNE） was performed in 39 cases of parathyroid adenoma. 2 cases of 4 parathyroid hyperplasia were performed by UNE and the other 2 eases were by bilateral neck exploration （BNE）. The procedures for 3 cases of parathyroid carcinoma were the same as that for papillary thyroid carcinoma. Emergency excision of parathyroid adenoma was performed in a patient with parathyroid storm, and the symptoms subsided postoperatively. All eases developed hypocalcemia in various degree after surgery,and symptoms were relieved with the use of calcium gluconate. Conclusion Serum calcium and PTH assays are both reliable methods for the diagnosis of PHPT. ^99mTc-MIBI should be considered as the most sensitive method for preoperative localization in patients with PHPT.UNE is an acceptable approach for the patients with definitive preoperative lesions localization.