原发性甲状旁腺功能亢进外科手术临床分析

The clinical analysis of surgical treatment of primary hyperparathyroidism

目的探讨原发性甲状旁腺功能亢进（PHPT）外科手术治疗特点。方法回顾性分析我院2000-2011年收治的48例PHPT患者临床资料。结果48例PHPT患者均经手术、病理证实，临床表现多样化。术前联合B超、CT及甲状旁腺核素扫描，定位诊断准确。手术方式以直接单侧甲状旁腺腺瘤切除术为主，占83．3％，一次手术治愈率为97．9％。术后随访5个月-10年，除2例严重骨畸形、1例甲状旁腺癌骨转移改善不明显外，其余相关症状及体征均不同程度缓解，无永久性甲状旁腺功能减退症或喉返神经损伤等并发症。结论甲状旁腺切除术是治疗原发性甲状旁腺功能亢进的唯一有效方法，80％以上患者经术前影像学定位后行单侧甲状旁腺直接切除可达到治愈效果．配合术者清晰的解剖、术中规范化操作可明显降低术后并发症，提高生存率。对于部分解剖变异、定位不清或考虑癌变者仍需大范围探查。

Objective To investigate the surgical treatment characteristics of primary hyperparathyroidism （PHPT）. Methods The clinical data of 48 cases of patients with PHPT who were treated in our hospital from 2000 to 2011 were analyzed ret- rospectively. Results 48 patients with PHPT were confirmed by operation and pathology. There were various clinical mani- festations. Combination of B ultrasound, CT and parathyroid nuclide scanning could accurately position lesions. Direct uni- lateral parathyroid adenoma resection was the main operation method, accounted for 83.3%, and the cure rate of one-time surgery was 97.9%. The following up lasted from 5 months to l0 years after operation, except 2 cases of severe bone defor- mity, 1 case of parathyroid carcinoma with bony metastasis had no obvious improvement, the symptoms and signs of others were all relieved to varying extents. There was no permanent hypoparathyroidism or recurrent nerve injury or other compli- cations. Conclusion Parathyroidectomy is the only effective treatment method for primary hyperparathyroidism. More than 80% patients who underwent unilateral parathyroidectomy after preoperative imaging positioning can achieve effect of cure, coordinating with the clear anatomical structures, standardized operating of surgeon, it can significantly reduce postopera- tive complications and improve survival rate. Patients with anatomical variation, unclear positioning and considered cancer- ation still need bilateral exploration.