甲状旁腺原发占位性病变的临床诊治  

Diagnosis and treatment of primary parathyroid occupying lesions

作　　者：陶晓峰[1] 刘畅[2] 白艳[1] 付明杰[1] 王燕霞[1] 

机构地区：[1]大连市中心医院病理科,大连116033 [2]大连市中心医院内分泌科,大连116033

出　　处：《临床耳鼻咽喉头颈外科杂志》2014年第6期369-372,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨甲状旁腺占位性病变的临床表现、诊断和治疗方法。方法:回顾性分析我院2003-01-2012-10期间收治的26例甲状旁腺占位性病变患者的临床资料。结果:26例患者中,甲状旁腺腺癌2例,甲状旁腺腺瘤11例,甲状旁腺囊肿13例。临床表现除13例为囊肿外,均伴有甲状旁腺功能亢进症状,其中颈部肿物26例,骨质疏松或骨纤维囊性变11例,泌尿系统症状9例,消化系统症状8例。定性诊断依赖于血钙及甲状旁腺激素(PTH)水平的测定。术前定位检查主要依靠B超、CT、MRI等影像学手段。2例甲状旁腺腺癌患者、11例甲状旁腺腺瘤患者和13例甲状旁腺囊肿患者术前与术后诊断符合率分别为0(0/2)、91%(10/11)、69%(9/13)。所有患者均行手术治疗,2例甲状旁腺腺癌患者术后分别随访17个月和27个月均无瘤生存;11例甲状旁腺腺瘤患者手术治疗后,症状缓解,均未见复发;13例甲状旁腺囊肿患者术后均未见复发。结论:甲状旁腺占位性病变缺乏特异性临床表现,颈部肿物为常见表现。血清钙离子及PTH水平的测定结合B超、CT、MRI和99mTc-MIBI等影像学有助于甲状旁腺占位性病变的诊断。甲状旁腺腺癌术前诊断困难。甲状旁腺占位性病变确诊主要依靠病理学诊断。手术为甲状旁腺占位性病变的首选治疗方式。Objective： To investigate the clinical manifestation, diagnosis, treatment of parathyroid occupying lesions. Method： The clinical data of 26 patients with parathyroid occupying lesions between January 2003 and October 2012 at Dalian Central Hospital were retrospectively analyzed. Result： There were 2 cases of parathyroid cancer, 11 cases of parathyroid adenoma, 13 cases of parathyroid cysts in this study. All the cases, except 13 cases of cysts,are accompanied by symptoms of hyperparathyroidism. The symptoms were as follows： 26 cases of neck lump, 11 eases of osteoporosis/osteitis fibrosa cystica,9 cases of urinary symptom,8 cases of digestive symptom . Serum ealciumion level and serum parathyroid hormone（PTH） level were examined qualitatively before operation. Ultrasonography,CT,MRI were used in diagnosing and locating parathyroid occupying lesion before operation. 2 eases of parathyroid cancer,ll eases of parathyroid adenoma and 13 cases of parathyroid cysts with preoperative and postoperative diagnosis coincidence rate was 0 （0/2）, 91% （10/11）, 69% （9/13）. All patients were treated with operation. 2 cases of parathyroid cancer survived with out recurrence during follow up for 17 months and 27 months after operation. 11 cases of parathyroid adenoma and 13 cases of parathyroid cysts were treated with operation,achieved complete remission and the outcome was no recurrence. Conclusion： There lack of specific clinical symptoms of parathyroid occupying lesions, neck lump are common manifestations. Examination of serum calcium and PTH level together with ultrasonography, CT, MRI,99m Tc-MIBI is helpful to diagnose parathyroid occupying lesions. Parathyroid cancer preoperative diagnosis is difficult . Parathyroid occupying lesions determine the diagnosis depends on pathology. Surgery should be done as primary treatment.

关 键 词：甲状旁腺肿瘤 诊断 甲状旁腺切除术 

分 类 号：R736.2[医药卫生—肿瘤]