以泌尿系结石首发的原发性甲状旁腺功能亢进症的诊治分析

Diagnosis and treatment of primary hyperparathyroidism initially with urinary calculus

目的：探讨以泌尿系结石首发的原发性甲状旁腺功能亢进症（ primary hyperparathyroidism ， PHPT）的临床诊断及治疗。方法回顾性分析河南大学淮河医院近10年来收治的26例以泌尿系结石首发的PHPT的临床资料。结果本组病例中双侧上尿路结石22例，单侧4例，术前均有泌尿系统症状。彩超、CT及放射性核素检查有助于定位诊断。24例行经皮肾镜或输尿管镜气压弹道碎石术，2例输尿管结石自行排出。所有患者均行手术治疗PHPT，均经术中冰冻病理及术后常规病理检查证实诊断。术后临床症状明显改善。术前血钙、尿钙、甲状旁腺激素明显升高，术后下降，差异有统计学意义（ P＜0.05）；术前血磷明显降低，术后升高，差异有统计学意义（ P＜0.05）。结论以泌尿系结石首发的PHPT的诊断应重视实验室检测及影像学检查，手术治疗可明显降低结石复发率和改善肾功能。

Objective To investigate the diagnosis and treatment of primary hyperparathyroidism （ PHPT） initially with urinary calculus .Methods The clinical data of 26 patients who diagnosed as PHPT ini-tially with urinary calculus were retrospectively reviewed .Results There were 22 cases with bilateral urinary calculus and 4 cases with unilateral relapsed urinary calculus .Ultrasonography , CT and radionuclide were helpful to determine the location of the neoplasia .24 cases underwent percutaneous nephroscope or ureteroscopy pneu-matic ballistic lithotripsy , 2 cases discharged ureteral calculi by themselves .All patients were performed surgical treatment of PHPT , which was confirmed by intraoperative frozen pathology and postoperative pathological exami -nation.There was great improvement of clinical symptoms after surgical procedures .The preoperative serum calci-um, urine calcium and parathyroid hormone elevated , while serum phosphate decreased .The postoperative indi-cators were just the opposite .The difference had statistical significance （ P〈0.05 ） .Conclusions Laboratory investigations and imaging studies are very important to diagnose PHPT initially with urinary calculus .The para-thyroid surgery can remarkably reduce the calculus recurrence and improve renal function .