原发性甲状旁腺功能亢进症19例分析  

The Clinical Analysis of 19 Cases with Primary Hyperparathyroidism

作　　者：王越琦[1] 闾晨涛[1] 锁涛[1] 顾大镛[1] 

机构地区：[1]复旦大学附属中山医院普外科,上海200032

出　　处：《中国临床医学》2009年第5期809-811,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨原发性甲状旁腺功能亢进症的诊断及外科治疗经验。方法:回顾分析2003年4月—2008年5月行手术治疗的19例原发性甲状旁腺功能亢进症(PHPT)患者的临床资料。结果:全组19例PHPT均经手术和病理证实。女性明显多于男性,临床表现多样化,病程迁延。17例术前血钙及甲状旁腺激素不同程度增高。影像学检查的阳性率:B超为73.33%,CT为60.00%,MRI为75.00%,99mTc-MIBI为100.00%。19例患者均经颈前弧形切口行甲状旁腺切除术,16例为甲状旁腺腺瘤;2例为甲状旁腺腺瘤伴灶性癌变;1例为甲状旁腺增生。术后随访10个月至6年,17例无复发,1例因甲状腺肿瘤再次手术,1例失访。结论:B超和99mTc-MIBI检查可作为诊断甲状旁腺疾病的首选定位诊断方法,同时行此两项检查能提高对甲状旁腺组织定性与定位诊断的准确性。手术切除是最佳的治疗方式。对于多个甲状旁腺增生、甲状旁腺癌和同时伴有甲状腺疾病患者,推荐经颈前弧形切口甲状旁腺切除术为首选手术方式。Objective： To summarize the experience of diagnosis and surgical treatment of primary hyperparathyroidism （PHPT）. Methods：The clinical data of 19 patients with PHPT who underwent parathyroidectomy from 2003 to 2008 were analyzed retrospectively. Results： All the 19 patients with PHPT were confirmed by operation and pathology. There were more fe- male than male patients. There were various clinical manifestations, and the duration of illness was protracted. Hypercalcemia and high level of PTH were discovered in 17 patients. Imaging studies showed that the positive rate of the ultrasound was 73.33% ,the CT was 60.00% ,the MRI was 75.00% ,and the 99mTc-MIBI was 100.00%. All the patients were underwent parathyroidectomy of front neck incision, and were identified with parathyroid adenoma in 16 cases, hyperplasia in 1case and carcinoma in 2 cases. Follow up was done from 10 months to 6 years after surgery. 17 cases were recovered without recurrence, 1 case was reoperated for the thyroid tumor and 1case losed the follow-up. Conclusion：Ultrasound and 99mWc MIBI examination should be considered as the first choice of locating diagnosis for the parathyroid diseases. Combination of the 2 imaging methods could significant improve the accuracy of identification and location. Parathyroidectomy is the best approach for patients with PHPT. Parathyroidectomy of front neck incision is the first choice for the patients who have several parathyroid hyperplasia,or have been diagnosed as the parathyroid carcinoma, or have the thyroid tumor also.

关 键 词：原发性甲状旁腺功能亢进症 甲状旁腺腺瘤 外科手术 

分 类 号：R582.2[医药卫生—内分泌]