原发性甲状旁腺功能亢进症定性诊断与手术方式探讨

Qualitative Diagnosis of PHPT and the Operation Methods of PHPT

目的:目前原发性甲状旁腺功能亢进症的术前诊断较为困难,不同手术方式对预后的影响也不一样。本文探讨原发性甲状旁腺功能亢进症定性诊断方法与手术方式,提高诊断准确率,并针对不同病因采取不同手术方式,尽可能改善患者预后。方法:选取我院36例确诊为PHPT的患者,经不同检查方法组合(实验室检查+X线影像检查,实验室检查+B超检查、99 Tcm-甲氧异丁基异腈核素扫描检查,X线影像检查+B超检查、99 Tcm-甲氧异丁基异腈核素扫描检查,实验室检查+X线影像检查+B超检查、99 Tcm-甲氧异丁基异腈核素扫描检查)进行检查,采用统计学软件spss13.0经行统计学分析,比较各组之间的诊断符合率。结果:4种方式结合(实验室检查+X线影像检查+B超检查+99Tcm-甲氧异丁基异腈核素扫描检查)检查的诊断符合率最高;针对不同原发性甲状旁腺功能亢进症的病因,采取不同手术方式进行治疗,甲状旁腺腺瘤、甲状旁腺增生治疗效果好,腺癌例数不足,手术效果需进一步证实。结论:实验室检查,X线影像检查,B超,99 Tcm-甲氧异丁基异腈(sestamibi,MIBI)核素扫描检查的结合对PTPH的定性诊断效果好,对于不同的PHPT病因,正确选择手术方式可以改善患者的预后。

Objective： At present,the preoperative diagnosis of PHPT（primary hyperfunction of parathyroid） is difficult, the effects of different surgical methods on prognosis is different,This article is to discuss the diagnosis and operation methods of PHPT and improve the diagnostic accuracy. according to different causes we take different ways of operation to improve the prognosis of patients as far as possible. Methods： 36 patients with PHPT who were diagnosed and treated by various combined inspections（Laboratory examination＋ X-ray, Laboratory examination ＋ ultrasound ＋ 99 Tcm- MIBI, X-ray ＋ ultrasound ＋ 99 Tcm- MIBI, Laboratory examination ＋ X-ray＋ ultrasound ＋ 99 Tcm- MIBI） in our hospital were selected, and the diagnosis coincidence rate of patients treated by different methods was analyzed and compared by spss13.0 statistical software. Results： Among all the examinations, 4 combined ways of examination（Laboratory examination ＋ X-ray＋ultrasound ＋ 99 Tcm- MIBI） has the highest diagnosis coincidence rate. According to different causes of PHPT, we used different surgical methods, the treatment effects of parathyroid adenoma and parathyroid hyperplasia is good, the cases of adenocarcinoma is insufficient, so the surgery effect need to be further confirmed. Conclusion： Laboratory examination, X-ray examination, B ultrasound and MIBI nuclide scan have great effect on the PTPH qualitative diagnosis.According to different causes of PHPT, selecting the right surgical methods can improve the prognosis of patients.