原发性甲状旁腺机能亢进症的诊治

Diagnosis and treatment of primary hyperparathyroidism

目的 探讨原发性甲状旁腺机能亢进症 (PHPT )的诊断和治疗。方法 分析 1987年 7月～ 2 0 0 0年 5月收治的 7例晚期PHPT患者的临床资料。结果 甲状旁腺瘤 6例 ,其中骨型 3例 ,骨肾型 3例 ,均有误诊史 ,均行病变旁腺摘除术 ,术后随访无复发 ;甲状旁腺癌 1例 ,先后 3次因高钙危象急诊入院 ,曾行 3次手术治疗 ,于第 1次术后 2 3个月死于广泛转移。结论 为提高PHPT的早期检出率 ,宜将不明原因的慢性腰腿痛 ,复发性、多发性泌尿系结石 ,急性胰腺炎 ,溃疡病等病人作为门诊筛选PHPT的对象 ,行血Ca2 +,P3 - ,Cl- ,AKP检测。PHPT定性诊断一旦明确即应行甲状旁腺手术探查。

Objective To explore the diagnosis and treatment of primary hyperparathyroidism(PHPT). Methods Clinical data of 7 cases of PHPT were retrospectively analysed. Results 6 cases had parathyroidoma,and 1 case was parathyroid carcinoma. In the 6 parathyroidoma patients, 3 were with bone lesions and the other 3 with bone lesions and urinary calculus, All the a cases were misdiagnosed and underwent parathyroid adenoma resection,none of them had recurrence. The parathyroid carcinoma patient was admitted to the hospital for three times because of hypercalcemia crisis.The patient underwent 3 times operation,and died of extensive metastasis 23 month after the first operation. Conclusions To improve the diagnosis rate of PHPT, PHPT , outpatients with chronic waist-leg pain, recurrent urologic stone, acute pancreatitis and ulcer should check the level of Ca 2+ ,P 3- ,Cl - and AKP in the blood . Once the diagnosis is certain, the operation can be performed.