原发性甲状旁腺机能亢进症的术前诊断与临床并发症分型(附60例分析)

Preoperative Diagnosis and Classification of Complications of Primary Hyperparathyroidism, Analysis of 60 Cases

本文报告60例原发性甲旁亢(1963～1990)并给以临床分型。男25例,女35例。平均年龄34.2岁,平均病程5.6年。54例接受手术治疗,其中47例为腺瘤,5例增生与2例癌。另6例接受甲腈眯胍治疗。甲旁亢诊断主要依靠高血钙,低血磷,低血镁,AKP 升高,血 Cl/P 比值升高,PTH、BGP 升高,TRP 降低,以及尿钙、磷、镁、HOP 及 cAMP 升高。甲旁亢临床可并发多种疾病,41例骨病变,17例骨肾病变,2例肾结石,7例溃疡病,3例急性胰腺炎,4例危象,6例高血压和6例心脏病等十余种临床并发症。死亡4例(6.6%),术后预后较好。

Sixty eases of hyperparathyroidism were reported with clinical typing.Therewere 25 males and 35 females,with a mean age of 34.2 years and mean course of 5.6years.Among them,54 cases were operated.They included 47 cases of adenoma,5 ofparathyroid hyperplasia and 2 of parathyroid carcinoma.The other 6 cases were trea-ted with cimetidine.Hyperparathyroidism was suspected by hypercalcemia,hypophosphatemia,hypo-magnesemia and hypercalciuria.The plasma AKP level inereased only in the presenceof osteitis fibrosa or in association with other bone changes notably osteomalacia.The urinary P,HOP,cAMP and serum C1/P ratio were usually high,whereas TRPwas low.Serum BGP,PTH almost always increased.Hyperparathyroidism might be associated with many clinical conditions.Theseincluded bone diseases in 41,17 bone diseases with renal stones,renal stones in 2,duodenal ulcer in 7,acute panereatitis in 3,4 cases of crisis,6 of hypertension,6 ofheart diseases,etc.Four patients with hyperparathyroidism died(6.6%).The resultof this disease was satisfactory after surgery.