原发性甲状旁腺功能亢进症的外科诊治

Surgical diagnosis and treatment of primary hyperparathyroidism

目的:探讨原发性甲状旁腺功能亢进症(PHPT)的外科诊治经验。方法:回顾性分析2002—2012年间收治的86例PHPT患者的临床资料。结果:首发症状表现为骨骼系统病变45例,泌尿系统症状21例,消化道症状14例;无症状者6例。术前86例患者平均血钙浓度(3.13±0.46)mmol/L,甲状旁腺素(PTH)中位浓度864.6 pmol/mL。B超检出率90.3%,99mTc-MIBI检出率95.0%,CT检出率78.6%。58例单纯单发甲状旁腺瘤(其中包括异位甲状旁腺腺瘤5例)行单侧颈部探查术;11例双侧甲状旁腺腺瘤,15例单发甲状旁腺腺瘤合并双侧结节性甲状腺肿,2例甲状旁腺增生行双侧颈部探查术。术后成功随访80例,时间3个月至6年,所有患者均无复发。结论:血钙、血PTH是PHPT定性诊断的主要依据,B超、99mTc-MIBI是PHPT主要定位手段。手术治疗是最有效的方法,单侧颈部探查术是常用术式。

Objective： To investigate the surgical diagnosis and treatment of primary hyperparathyroidism （PHPT）. Methods： The clinical data of 86 PHPT patients treated between 2002 and 2012 were retrospectively analyzed. Results： Of the patients, the initial symptoms presented in 45 cases as skeletal disorders, in 21 cases as urological problems, and in 14 cases as gastrointestinal upsets; six cases had no obvious symptoms. The mean calcium level was （3.13＋0.46） mmol/L and the median parathyroid hormone （PTH） level was 864.6 pg/mL in patients before operation. The detection rate of diseases by ultrasound, 99mTc-MIBI, and CT was 90.3%, 95.0% and 78.6%, respectively. Unilateral neck exploration was performed in 58 patients with a solitaryparathyroid adenoma （including 5 cases of ectopic parathyroid adenoma）, and bilateral neck exploration was performed in 11 patients with multiple parathyroid adenomas, 1S patients with parathyroid adenoma combined with bilateral nodular goiter and 2 patients with parathyroid hyperplasia. Eighty cases were followed up for 3 months to six years, and all of them survived without recurrence. Conclusion： For PHPT, the calcium and PTH levels are the bases for qualitative diagnosis; ultrasound and 99mTc-MIBI are the main approachs for localization; surgery is the most effective treatment method and unilateral neck exploration is the common procedure.