老年患者甲状旁腺肿瘤诊断和手术治疗

Diagnosis and surgical treatment of parathyroid tumors in elderly patients

目的探讨老年患者甲状旁腺肿瘤临床特点和手术疗效。方法回顾性分析12例老年甲状旁腺肿瘤患者临床表现、治疗方法及其疗效，其中男、女性各6例，年龄60-83岁，甲状旁腺腺瘤8例，甲状旁腺癌4例，病史3．2～10．0年，平均病史5．3年。其中，以骨骼肌肉系统症状为主诉者9例次，以消化系统症状为主诉者7例次，以泌尿系统症状为主诉者6例次。血甲状旁腺激素（PTH）78～2850μg／L，血钙2．6～4．5mmol／L。甲状旁腺腺瘤切除8例次，甲状旁腺癌扩大切除术6例次，术中及术后行血PTH及血钙检测。结果肿瘤切除后10min内患者外周血PTH值降幅均大于50％，术后2hPTH正常或低于正常，24h内出现低血钙，12例患者出现不同程度肢体或头面部麻木感，骨痛或行动困难等主要症状术后1周内均显著改善。随诊18～48个月，定期复查PTH及血钙，其中9例PTH、血钙监测均在正常范围，2例甲状旁腺癌患者分别于本次手术后1年、2年再次复发行手术治疗，仍在随访中，1例甲状旁腺腺瘤伴心衰、呼衰等严重合并症患者出院1周后突然呼吸困难死亡。结论不明原因骨关节痛、骨质疏松、泌尿系结石老年患者宜行血PTH及血钙检测，切除老年患者甲状旁腺肿瘤安全有效；老年甲状旁腺肿瘤患者术后密切监测血钙、及时纠正低钙血症具有重要意义。

Objective To evaluate the clinical features and efficiency of surgical treatment in elderly patients with parathyroid tumor. Methods Clinical data of 12 cases （aged 60-83 years） was retrospectively analyzed. Their main complaints varies individually, including bone and muscle trouble in 9 patients, abdominal problem in 7 ones, and kidney stone in 6 ones. PTH level ranged from 78 to 2850 rig^L, and calcium level 2.6-4. 5 mmol/Lo Parathyroidectomy was carried out in 8 patients, while extended excision of suspected tissues in 6 ones. Intraoperative PTH determination was routinely performed. Results A drop by at least 50~ in PTH level was achieved in all cases after 10 minutes of tumor-bearing tissues excision. A much improvement of main complaints was shown in all cases about 1 week postoperatively. During the follow-up period from 18 to 48 months, both PTH and calcium levels were still in normal range in 9 patients, relapse was noticed in two cases 1 or 2 years after operation respectively. One patient died even after successful excision of parathyroid tumor. Conclusions PTH and calcium level determination is advised in elderly patients with suspected parathyroid tumor, and surgical treatment is generally safe and effective.