原发性甲状旁腺功能亢进症的诊断和治疗

Diagnosis and surgical treatment of primary hyperparathyroidism

目的探讨原发性甲状旁腺功能亢进症 (primaryhyperparathyroidism ,PHPT)的诊治方法。方法回顾性分析 90例PHPT的临床资料。结果血钙大于 2 6 5mmol/L ,伴血PTH同步升高为定性诊断PHPT的主要依据。B超定位甲状旁腺腺瘤的特异性为 95 % ,而99mTc MIBI的敏感性为 10 0 %。经双侧甲状旁腺探查发现下旁腺较上旁腺更易受累。良性病变 1次手术成功率 99%。结论PHPT的定性诊断依据血钙和PTH的同步升高 ,结合颈部B超和MIBI能取得较为准确的术前定位。双侧颈部探查并切除甲状旁腺肿瘤安全有效。

ObjectiveTo summarize the experience in diagnosis and surgical treatment of primary hyperparathyroidism (PHPT). Methods Ninety cases were recruited into this study from Sept. 1956 to Jul. 2001 in our hospital. Results We diagnosed PHPT by calcemia> 2.65 mmol/L with co-elevated PTH. For locating the adenoma, the specificity of B-Us was 95% and the sensitivity of MIBI was 100%. Our standard surgical procedure were bilateral exploration. We found much more tumors in inferior glands than that in superior glands. The success rate in a single exploration in benign cases was 99%. Conclusions PHPT could be diagnosed by co-elevated calcemia and PTH. B-US with 99m Tc-MIBI was the first choice for localization. Bilateral exploration is safe and effective.