原发性甲状旁腺功能亢进症的诊断与治疗（附62例报告）  

Diagnosis and surgical treatment of primary hyperparathyroidism： a report of 62 cases

作　　者：罗智勇[1] 胡晓鹏[1] 刘玥[1] 吴亚群[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院甲状腺乳腺外科,武汉430030

出　　处：《临床外科杂志》2014年第4期281-283,共3页Journal of Clinical Surgery

摘　　要：目的 探讨原发性甲状旁腺功能亢进症（PHPT）的诊治方法.方法 回顾性分析我院2000年1月至2013年8月收治的62例患者的临床资料.结果 62例PHPT中骨型19例,肾型11例,混合型21例,无症状型11例.61例手术者中1例左侧甲状旁腺癌联合行左侧甲状腺叶切除和左侧中央组淋巴结清扫术,2例开胸切除纵隔内异位甲旁腺腺瘤,3例双侧病变行双侧探查术,55例单侧病变行单侧探查术.结论 定性诊断主要依据血钙和甲状旁腺激素升高,定位诊断彩超、99mTc-MIBI和薄层CT敏感性高,联合多种影像学方法术前定位应列为首选.定位明确者可直接单侧探查,定位不明确、双侧病变、复发者或异位者可行双侧探查或在核素扫描指导下探查.Objective To investigate the diagnosis and surgical treatment of primary hyperparathyroidism（PHPT）.Methods The clinical data of 62 patients with PHPT in our hospital from January 2000 to August 2013 were retrospectively reviewed.Results In all 62 cases of PHPT,19 cases had pathologic bone changes,11 cases had urinary stones,21 cases had both pathologic bone changes and urinary stones,and 11 cases were asymptomatic.In the 61 cases with surgery,l case with parathyroid carcinoma on the left side was performed with left lobectomy with central lymph node dissection.Two cases with ectopic mediastinal parathyroid adenoma were treated with parathyroidectomy through thoracic incisions.Bilateral neck exploration was performed in 3 cases with bilateral lesions.The rest cases underwent unilateral exploration.Conclusion Serum calcium and parathyroid hormone are both reliable markers for the diagnosis of PHPT.Ultrasonography,99mTc methoxy isobutyl isonitrile （99m Tc-MIBI）and thin-section computed tomography（CT） were highly sensitive,and the combination of multiple imaging methods should be considered as the first choice for preoperative localization.Unilateral exploration could be performed in patients with clear localization.Bilateral neck exploration and radionuclide scanning could be considered in patients with unclear localization,bilateral or ectopic lesions.

关 键 词：原发性甲状旁腺功能亢进 诊断 治疗 

分 类 号：R653[医药卫生—外科学]