甲状旁腺腺瘤囊性变临床特点分析(附8例报告)

Clinical features and diagnosis of parathyroid adenoma with cystic degeneration:A report of 8 cases

目的探讨甲状旁腺腺瘤囊性变的临床特点。方法回顾性分析2003年1月至2012年8月中国医科大学附属盛京医院普外科行手术治疗并经病理证实的58例甲状旁腺腺瘤病人,其中囊性变病例8例,对比分析甲状旁腺腺瘤囊性变与无囊性变病例的术前血钙、甲状旁腺素(PTH)、有无甲状旁腺危象、病变大小、临床诊断方法等。结果两组间术前血钙、PTH及有无甲状旁腺危象差异均无统计学意义。甲状旁腺腺瘤囊性变组,其平均最大径大于无囊性变组,平均值为(37.1±13.8)mm vs.(23.6±11.4)mm,二者差异有统计学意义(P<0.01)。全部甲状旁腺腺瘤病例中,超声、CT与99mTc-甲氧基异丁基异腈(99mTc-MIBI)核素扫描三种检查方法的敏感性、准确性与阳性预测值,分别为82.1%,79.3%,95.8%;66.7%,66.7%,100.0%;71.4%,68.2%与93.8%。3种检查指标差异均无统计学意义。甲状旁腺腺瘤囊性变组,超声诊断敏感率性低于无囊性变组,分别为37.5%与89.6%,二者比较差异有统计学意义(P<0.01)。结论甲状旁腺腺瘤囊性变临床表现与无囊性变病例相同,术前血钙及血PTH值无差异,病灶大,不增加甲状旁腺危象的发生率。发生囊性变后误诊率偏高,应结合超声及99mTc-MIBI核素扫描等检查。

Objective To evaluate the clinical features and diagnosis of parathyroid adenoma with cystic degeneration. Methods The clinical data of 8 cases of parathyroid adenoma with cystic degeneration and 50 cases of parathyroid adenoma without cystic degeneration performed surgery and identified by pathology between January 2003 and August 2012 in Department of General Surgery, Affiliated Shengjing Hospital of China Medical University were analyzed retrospectively. The serum calcium, serum parathyroid hornone （PTH）, parathyroid crisis, lesion size and diagnosis methods between cystic degeneration group and no cystic degeneration group were compared and analyzed. Results There was no difference in serum calcium, serum PTH and incidence of parathyroid crisis between two groups. The mean largest diameter of lesion in cystic degeneration group was （37.1±13.8 ）ram, in no cystic degeneration group it was （23.6±11.4） ram, there was statistical difference between two groups （P〈 0.01）. In all parathyroid adenomas, the sensitivity, accuracy, positive predictive value in uhrasonography, CT and MIBI scintigraphy was 82.1%, 79.3%, 95.8%; 66.7%, 66.7%, 100.0%; 71.4%, 68.2% and 93.8% respectively. There was no statistical difference among the three groups. The sensitivity of ultrasonography in cystic degeneration group was 37.5%, lower than it in no cystic degeneration group （89.6%）, there was statistical difference between two groups （P 〈 0.01）. Conclusion In both parathyroid adenoma with cystic degeneration group and no cystic degeneration group, the clinical feature is the same. There is no difference in serum calcium and serum PTH, and cystic degeneration does not increase the incidence of parathyroid crisis, while size is larger in cystic degeneration group. When cystic degeneration happened, the misdiagnosis increases, it should use both ultrasonography and MIBI scintigraphy for the diagnosis.