原发性甲状旁腺功能亢进的诊断和治疗  

Diagnosis and treatment of primary hyperparathyroidism

作　　者：顾军[1] 于泽平[1] 王少华[1] 

机构地区：[1]南京军区南京总医院解放军普通外科研究所,江苏南京210002

出　　处：《医学研究生学报》2008年第12期1285-1287,共3页Journal of Medical Postgraduates

基　　金：南京军区南京总医院科研基金资助项目(批准号:2005045)

摘　　要：目的：探讨原发性甲状旁腺功能亢进（PHPT）的诊断和治疗。方法：回顾性分析4年间收治8例PHPT患者的临床资料。结果：PHPT发病年龄为15~75岁,女性明显多于男性,临床表现多样,病程迁延,误诊率高。8例患者术前诊断均结合超声、99m锝-甲氧基异丁基异腈（99mTc-MIBI）和CT等检查。所有患者血清钙升高和甲状旁腺素（PTH）检查均增高。8例PHPT患者均经手术治疗、病理证实,手术方式以直接甲状旁腺腺瘤切除术为主。术后患者症状改善,血清钙、PTH值明显下降。手术后无永久性甲状旁腺功能减退和喉返神经损伤等并发症。结论：超声和放射性核素发射式计算机断层显像（ECT）可作为首选的定位诊断方法,定性诊断主要依靠血钙和甲状旁腺素升高。定位明确的甲状旁腺腺瘤可行单侧探查;要注意术后低钙血症的处理。Objective ： To explore the diagnosis and treatment of primary hyperparathyroidism （PHPT）. Methods ： The clinical data of 8 cases of PHPT were retrospectively analyzed. Results ： The patients, 3 males and 5 females, and aged 15 -75 years, had various clinical manifestations, with protracted disease course and high rate of misdiagnosis. Ultrasound, 99mTc-MIBI and CT examinations were performed pre- operatively. Elevated levels of serum calcium and parathyroid hormone （PTH） were observed and PHPT was confirmed by surgery and pathology in all the patients. Direct parathyroidectomy was the major surgi- cal method. After the operation, serum calcium and PTH came down, and there was no permanent hypot- hyroidism or recurrent nerve injury. Conclusion ： PHPT can be confirmed by concurrent elevation of se- rum calcium and PTH; uhrasonography and emission computed tomography （ECT） are the first-choice methods for preoperative localization; and unilateral neck surgery （UNE） of parathyroidoma could be considered if accurate image localizations are available. Monitoring and management of hypoealcemia are very important after the operation.

关 键 词：原发性甲状旁腺功能亢进 甲状旁腺腺瘤 外科手术 

分 类 号：R582.1[医药卫生—内分泌]