原发性甲状旁腺功能亢进症85例临床及病理分析

Clinical and pathological analysis of primary hyperparathyroidism in 85 cases

目的探讨原发性甲状旁腺功能亢进症(PHPT)的临床表现和病理诊断。方法对该院收治的85例PHPT患者的临床和病理资料进行回顾性分析。结果 85例患者发病平均年龄(36.0±13.2)岁,女性明显多于男性,临床症状复杂,误诊率为81.2%(69/85)。PHPT定位检查:99 Tcm-MIBI扫描敏感性为95.4%(62/65),B超敏感性为80.0%(60/75),CT敏感性为63.0%(34/54)。85例PHPT中,甲状旁腺腺瘤81例,甲状旁腺增生1例,甲状旁腺腺癌3例。甲状旁腺癌中2例血钙水平高于中位数,1例并发甲状旁腺危象。甲状旁腺腺癌中1例曾于4年前诊断为甲状旁腺非典型腺瘤。结论对骨痛、骨质疏松、泌尿系结石的患者,应注意筛查PHPT。PHPT的定位检查首选99 Tcm-MIBI扫描,同时结合甲状旁腺B超和CT。甲状旁腺非典型腺瘤须注意随访,警惕肿瘤复发或发生腺癌。

Objective To explore the clinical manifestations,diagnosis and pathology diagnosis of primary hyperparathyroidism（PHPT）.Methods A retrospective study of 85 consecutive patients with PHPT was performed.Results Among the 85 cases,including 25 males and 60 females,the age ranged from 12 to 72（average 36.0±13.2） years.The clinical manifestations were various.Misdiagnosis rate was 81.2%（69/85）.The diagnostic sensitivity of 99Tcm-MIBI was 95.4%（62/65）,ultrasound 80.0%（60/75）and CT 63.0%（34/54）,respectively.81 patients were with pathologically proven parathyroid adenomas,1 case with hyperplasia and 3 cases with carcinomas.Among the 3 cases with parathyroid carcinomas,the levels of serum calcium in 2 cases were above median and 1 case was with parathyroid crisis.1 case with parathyroid carcinomas was diagnosed as atypical adenomas 4 years ago.Conclusion The screening for PHPT in patients with bone pains,osteoporosis and urinary calculi is recommended.99Tcm-MIBI is preferred for the localization and with the combination of 99Tcm-MIBI,B ultrasound and CT may improve the diagnostic accuracy of PHPT.Our data supports watchful follow up for atypical parathyroid adenomas because of the risk of recurrence and malignancy.