甲状旁腺癌的诊断和治疗（附9例分析）  

Diagnosis and treatment of parathyroid carcinoma：9 cases report and literature review

作　　者：徐少明[1] 王平[1] 陈丽荣[2] 李志宇[1] 李国刚[1] 

机构地区：[1]浙江大学医学院附属第二医院普通外科,杭州310009 [2]浙江大学医学院附属第二医院病理科,杭州310009

出　　处：《中华外科杂志》2010年第12期886-890,共5页Chinese Journal of Surgery

摘　　要：目的 探讨甲状旁腺癌的诊断和治疗.方法 回顾分析1967年1月至2009年12月收治的9例甲状旁腺癌的诊治经验并总结国内文献报道的部分甲状旁腺癌的相关病例资料.结果 本组9例中8例为本院病例,占本院原发性甲状旁腺功能亢进患者的8.9%（8/90）,1例为外院手术后转入.8例伴重度甲状旁腺功能亢进,1例无功能;据术前资料、术中探查和冰冻病理检查诊断为甲状旁腺癌共8例;院外1例误诊.初次手术采用颈部小切口下直接手术：2例甲状旁腺肿瘤切除;5例行肿瘤扩大切除术,其中3例加中央区淋巴结清扫术;1例行甲状旁腺癌姑息性切除术;外院1例仅行甲状腺次全切除术,后追加中央区淋巴结清扫术.均经术后病理确诊为甲状旁腺癌,无颈淋巴结转移.随访1～14年,8例无癌复发,1例姑息手术者术后2年死亡.国内相关文献中报道甲状旁腺癌加本组共146例,在原发性甲状旁腺功能亢进中发生率为1.8%～11.5%.结论 根据重度高钙血症的临床表现、B超、Tc^99m-sestemibi检查、术中探查见肿瘤与周围粘连和病理检查结果可诊断为甲状旁腺癌;初次手术方法宜采用包括同侧相邻组织和甲状腺在内的肿瘤扩大切除术,可用微创小切口手术施行,预后良好.Objective To investigate the diagnosis and surgical treatment of parathyroid carcinoma. Methods The clinical data of 9 cases of parathyroid carcinoma treated from January 1967 to December 2009 was analyzed retrospectively with the review of related Chinese literatures. Results Parathyroid carcinoma accounted for 8.9% （8/90）of all patients with primary hyperparathyroidism in our hospital, and the other one case was transferred from another hospital. Of the patients, 8 cases were found with primary hyperparathyroidism. Primary surgery was carried out with small incision： 5 patients underwent en bloc resection, among which, 3 cases received central lymph node dissection; 2 patients received simple parathyroidectomy; one case underwent palliative tumor resection. The case from another hospital received subtotal thyroidectomy. Considering preoperative, intraoperative data and frozen sections pathology, all patients were diagnosed as parathyroid carcinoma. Nine patients were followed-up for 1-14 years, no recurrence occurred, and the patient received palliative resection died from carcinoma two years after the operation. In previous Chinese literatures and this group, there were total 146 patients reported as parathyroid carcinoma. Those patients were diagnosed through routine histopathology, accounted for 1.8%-11.5% of patients with primary hyperparathyroidism. Conclusions The diagnosis of parathyroid carcinoma is established according to severe hypercalcemia, clinical features, subset B-ultrasound and Tc^99m-sestamibi scanning, intraoperative finding of adherence to close structures and histopathology. The initial surgical procedure of choice is en bloc resection of the tumor by minimally invasive small incision, including adjacent structures and ipsilateral thyroidectomy. The prognosis is favorable after the operation.

关 键 词：甲状旁腺肿瘤 甲状旁腺功能亢进症 诊断 治疗学 

分 类 号：R736.2[医药卫生—肿瘤]