肾石型原发性甲状旁腺功能亢进症9例报告——附文献复习  

Report of 9 cases of primary hyperparathyroidism with urolithiasis-literature review

作　　者：章璟[1] 姜宁[1] 王国增[1] 石泉[1] 李健[1] 顾燕[1] 郑景存[1] 马杰[1] 

机构地区：[1]上海市浦东新区公利医院泌尿外科,200135

出　　处：《中国医师进修杂志（外科版）》2008年第11期7-10,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨肾石型原发性甲状旁腺功能亢进症（PHPT）的诊断及治疗。方法对2000—2005年收治的881例肾结石患者中用简易代谢评估法初诊确诊并经手术和病理证实为PHPT9例患者的临床资料进行回顾和总结，并复习有关文献。结果9例PHPT患者术前血钙平均（2．96±0．48）mmol／L，术后平均（1．94±0．42）mmol／L；术前血清甲状旁腺激素（PTH）平均（1133．53±788．21）pmol／L，术后24h平均（74．52±49．17）pmol／L，手术前后血钙、PTH水平比较差异均有统计学意义（P值均〈0．01）。随访14个月至6年，术后3个月内PTH均下降至正常范围，此后8例患者PTH、血钙、血磷维持于正常范围内，所有经治疗的输尿管结石3个月后均排尽，而肾结石无明显变化。结论肾结石患者中血钙升高是诊断肾石型PHPT的有利线索。血钙不高者PTH升高2倍以上也需考虑为PHPT。建议尿路结石患者初诊时应进行包括血清钙、磷代谢及PTH等在内的简易代谢评估。Objective To investigate the diagnosis .and treatment of primary hyperparathyroidism （PHPT） with urolithiasis. Methods The clinical data of 9 PHPT patients who were evaluated with simple metabolic evaluation in 881 urolithiasis from 2000 to 2005 were summarized and the references were reviewed. Results The level of serum calcium was （2.96 ± 0.48）mmol/L before operation, （ 1.94 ± 0.42） mmol/L after operation. The level of parathyroid hormone （PTH） was （ 1133.53 ± 788.21 ）pmol/L before operation, （74.52 ± 49.17 ）pmol/L after operation. The level of serum calcium and PTH changed significantly after the parathyroidectomy （P 〈 0.01 ）. Follow-up for 14 months to 6 years, the ureteral stones fragments with lithotripsy were clear after 3 months and followed without recurrence, although the renal stones without lithotripsy were followed with no significant change. Conclusions Increase of serum calcium or increase of PTH above double with normal serum calcium may be helpful for diagnosis of PHPT with urolithiasis. Ureteral stone with PHPT should be treated together. Renal stone with PHPT may be followed up after the parathyroidectomy, and be treated until the complications were occurred. It suggests that the malden diagnosed patient with urolithiasis should be added with simple metabolic evaluation, including serum calcium, phosphonium and PTH.

关 键 词：甲状旁腺功能亢进 原发性 尿路结石 研究方法 

分 类 号：R582.1[医药卫生—内分泌] R734.2[医药卫生—内科学]