14例甲状旁腺肿瘤的诊断与治疗  

Diagnosis and surgical treatment of 14 cases of parathyroid adenoma and parathyroid carcinoma

作　　者：施友元[1] 林秀安[1] 林曦[1] 

机构地区：[1]福建省肿瘤医院头颈外科,福建福州350011

出　　处：《现代肿瘤医学》2013年第4期749-751,共3页Journal of Modern Oncology

摘　　要：目的:探讨甲状旁腺腺瘤(PTA)和腺癌(PTC)诊断与外科治疗。方法:回顾性分析我院自1986年-2011年共收治的14例甲状旁腺肿瘤患者的临床资料。患者血钙水平为(3.27±0.36)mmol/L,甲状旁腺激素(PTH)水平为(1453.25±551.20)ng/L。恶性患者4例均可触及颈部肿块,有2例术中冰冻明确诊断甲状旁腺癌,另2例术中冰冻仅提示恶性肿瘤。良性肿瘤10例,术前仅4例明确诊断甲状旁腺肿瘤,另6例术中冰冻疑为甲状旁腺腺瘤。后经石蜡病理及免疫组织化学确诊。10例良性行甲状旁腺切除术加患侧甲状腺切除术,4例恶性行甲状旁腺切除术+患侧甲状腺切除+患侧颈淋巴结清扫术。结果:随访9-86个月患者血钙及PTH正常,1例术前颈淋巴结转移者术后10个月死于骨转移,余均无转移及复发。结论:甲状旁腺肿瘤术前诊断困难,结合血钙、PTH、血生化检查与超声、CT等影像学检查及99mTc-甲氧基异丁基异晴(MIBI)甲状旁腺显像检查有助于术前诊断。术中冰冻病理价值有限。手术治疗预后好。Objective：To study the diagnosis and surgical treatment of parathyroid adenoma（PTA） and parathyroid carcinoma（PTC）. Methods：A retrospective clinical analysis was made on 14 cases of PTA and PTC admitted from 1986 to 2011. Results：Among the 14 cases,10 cases were PTA and 4 cases were PTC. The serum calcium and PTH levels were elevated in 14 cases. Tumors resection was performed in all the 14 cases. Unilateral neck exploration was performed in 10 cases,bilateral exploration was performed in 4 cases,4 cases with PTC ipsilateral thyroid lobe excision and modified neck dissection were also performed. Clinical symptoms of all the patients were relieved after operation. No recurrent case was found, during flow- up period （from 9 to 86 months）in 14 cases. Conclusion：It is difficult to diagnose parathyroid tumor. Serum calcium and PTH assays are both reliable methods for the diagnosis of PTA and PTC. A combination of B - Us and 99mTc - MIBI scintigraphy is sufficient for locating adenomas. The surgical resection is a good treatment for these patients.

关 键 词：甲状旁腺腺瘤 甲状旁腺腺癌 诊断 外科治疗 

分 类 号：R736.2[医药卫生—肿瘤]