原发性甲状旁腺机能亢进症26例外科治疗分析

Surgical Treatment of Primary Hyperparathyroidism:Analysis of 26 Cases

目的 探讨原发性甲状旁腺机能亢进 (原发性甲旁亢 )的诊断、术前定位、手术原则及手术后低血钙的处理。方法 回顾分析 1962～ 1995年 12月间经手术治疗的原发性甲旁亢 2 6例资料。结果 本组病例中以骨骼、泌尿系病变为主要症状 ,生化检查中血钙、碱性磷酸酶、血甲状旁腺激素 (PTH)高于正常值。术前 B超定位准确率较高。2 4例为单发甲状旁腺腺瘤 ,1例为甲状旁腺增生 ,1例颈部探查未发现病变腺体。 2 5例术后出现低血钙症状。结论 B超检查具有重要价值。术中若快速病检证实为甲状旁腺腺瘤 ,同侧另 1枚腺体正常者 ,则仅切除腺瘤即可。术后适量补钙可减轻低血钙症状 。

Objective To discuss the diagnosis, localization,operative principle of primary hyperparathyroidism, and management of post operative hypocalcemia. Methods 26 patients with primary hyperparathyroidism were surgically treated between 1962 and Dec 1995.Results Abnormalities in skeletal or urinary systems were the most noticeable symptoms in most patients. Serum calcium, serum alkaline phosphatase (AKP) and parathyroid hormone (PTH) were all over the upper limit. The accuracy of preoperative localization with ultrasound was good. The adenoma of parathyroid was proven in 24 cases, hyperplasia in one case, normal in the rest one. 25 patients suffered form hypocalcemia after removal of diseased parathyroids ,and calcium was given to ameliorate hypocalcemia. Conclusion Ultrasound is a useful diagnostic method. Simple removal of the tumor is necessary, if it is pathologically established and the ipsilateral parathyroid is normal. Post operative hypocalcemia could appear and be alleviated by supplying calcium. Serum calcium concentration could be served in supplying calcium and is helpful in judging the operative effect.