肿瘤相关性低磷骨软化病的诊断和治疗

Diagnosis and Threapy of Tumor Induced Osteomalacia(TIO)

目的分析、探讨肿瘤相关性低磷骨软化病(tumor induced osteomalacia,TIO)患者的临床特点、诊断及外科治疗,提高对该病的认识。方法分析8例TIO患者的临床资料和实验室及影像学检查特点,其中男5例,女3例,年龄32~54岁,平均(43±7)岁,病程(115±85)个月。结果 8例患者均符合低磷骨软化的临床诊断,均成年起病;低血磷,尿磷水平高,血钙正常偏低水平,碱性磷酸酶升高,甲状旁腺激素基本正常。奥曲肽显像有1例阴性,7例提示生长抑素受体高表达。2例行CT检查,6例行MRI检查,2例行彩超检查,2例行全身骨扫描检查,4例行PETCT检查。明确定位后行手术治疗,术后病理明确诊断。结论 TIO有典型的临床特点,明确TIO肿瘤部位是外科治疗的前提,奥曲肽显像结合超声、CT及MRI有助于肿瘤的发现和定位,完整手术切除肿瘤是治疗的关键。

Objective To analyzethe clinical characteristics of tumor induced osteomalacia （TIO）.Methods To ana- lyze the clinical data of 8 patients with TIO in laboratory and imaging examination.Results 8 cases of patients were in line with the clinical diagnosis of low phosphorusosteomalacia.All patients were adults adults.They had low blood phos- phorus,highurinary phosphorus level, the normal low blood calcium level, elevated alkaline phosphatase, basic normal parathyroid hormone.Octreotide imaging revealed 1 negative case,7 cases with prompt high expression of somatostatin receptor.2 routine CT, 6 MRI, 2 regular color Doppler ultrasound, 2 whole body bone scan,4 PET-CT examinationwere performed.After a clear positioning, surgical treatment were adopted. Postoperative pathological diagnosis were con- firmed.Conclusion TIO shows typical clinical characteristics.Clear TIO tumor site is the premise and key of surgical resection,osteomalacia imaging,ultrasound,CT and MRI are valuable for the discovery of the disease and positioning.