甲状旁腺癌的诊断与治疗(附5例报告)  

The Diagnosis and Treatment of Parathyroid Carcinoma

作　　者：周扬[1] 龚日祥[1] 罗书画[1] 钟善琼[1] 

机构地区：[1]四川大学华西医院普外科,四川成都610041

出　　处：《华西医学》2009年第3期579-582,共4页West China Medical Journal

摘　　要：目的：总结和探讨甲状旁腺癌的诊断和治疗方法。方法：回顾性总结本院5例甲状旁腺癌的临床资料。结果：5例患者术前颈部均扪及质硬包块，平均血钙浓度为3．82mmol／L，平均PTH浓度为153．6pmol／L，4例术中发现周围浸润表现。5例中4例同时行甲状旁腺肿瘤和同侧甲状腺腺叶切除，1例仅行甲状旁腺肿瘤切除。5例术后均诊断为甲状旁腺癌。术后4例得到随访，时间4月～5年。其中2例术后无复发；1例于术后半年局部复发行患侧甲状腺切除，后无复发；1例因全身转移于术后8个月死亡。结论：甲状旁腺癌的诊断非常困难，异常高浓度血钙、血PTH及术中浸润表现和组织病理学特征是甲状旁腺癌诊断的重要依据99m^Tc—MIBI扫描及超声是病变定位的首选手段，肿瘤及其周围受侵组织的“整块切除”（en bloc resection）是首选的治疗方式。Objective：To summarize and investigate the diagnosis and treatment of parathyroid carcinoma. Methods： The clinical data of five patients with parathyroid carcinoma were retrospectively studied. Results： Five patients had palpable and firm neck mass,the mean calcium level of 5 patients was 3.82 mmol/L,the mean parathyroid hormone level was 153.6 pmol/L, four patients had manifestations of invasion in operation. Parathyroid carcinoma was diagnosed definitively in five patients. Parathyroidectomy and ipsilateral thyroidectomy was performed in four patients, and parathroidectomy was performed in one patient. Four patients were followed up for four months to five years. Two patients survival without recurrence,one patient had recurrence six months post operation, one patient died of the metastasis eight months later after operation. Conclusion： The diagnosis of parathyroid carcinoma is very difficult. Extremely high level of calcium and parathyroid hormone and the manifestations of invasion in operation and histopathologic feature are key points to diagnosis of parathyroid carcinoma. 99m^Tc-MIBI scintigraphy and uhrasonograph were preferred methods for localization. En bloc resection of the carcinoma was the preferred surgical approach.

关 键 词：甲状旁腺癌 诊断 治疗 

分 类 号：R736.2[医药卫生—肿瘤]