17例原发性甲状旁腺功能亢进症的外科治疗  

The analysis of diagnosis and managements for primary hyperparathyroidism in 17 cases

作　　者：霍景山[1] 陶世明[1] 陈务民[1] 庄志浩[1] 吴岷翰[1] 卢彦川[1] 吴日钊[1] 

机构地区：[1]广东省佛山市中医院外一科,广东佛山528000

出　　处：《中国现代医学杂志》2014年第10期85-88,共4页China Journal of Modern Medicine

摘　　要：目的总结原发性甲状旁腺功能亢进症（primary hyperparathyroidism,PHPT）的外科治疗体会。方法回顾性分析2001年9月~2013年3月行手术治疗的17例PHPT的临床资料。结果 17例PHPT中,腺体增生1例（5.88%）,腺瘤67例（94.12%）。临床表现包括骨质疏松15例,骨关节痛7例,病理性骨折5例,尿路结石4例,骨关节畸形4例,疲劳、乏力4例,无症状1例。17例术前均有血钙、血清碱性磷酸酶、甲状旁腺激素升高。血钙最高达3.56 mmol/L,平均2.68 mmol/L。血PTH最高2 500 pg/mL,平均677.8 pg/mL。血ALP最高达2 604.4 u/L,平均1 220 u/L。术前血磷最低达0.41 mmol/L,平均0.69 mmol/L。16例B超及CT检查示甲状旁腺病变。1例B及CT检查未发现病变,行99mTc检查,见前纵膈内甲状旁腺放射性核素浓聚。本组16例行颈部低位切口甲状旁腺探查手术：15例甲状旁腺腺瘤行单侧探查,1例为甲状旁腺增生,行双侧探查术。1例前纵膈内甲状旁腺瘤,行开胸探查病变,行腺瘤切除术。术后发生手足抽搐6例。所有患者均进行了随访,随访时间9个月~13年。甲状旁腺增生患者失访,余16例随访至今未见复发及术后死亡。4例骨关节畸形者术后半年~1年行矫形手术。4例尿路结石行碎石或切开取石术。结论注重甲状旁腺功能和血钙筛查、多学科合作有助于早期诊断;甲状旁腺切除术是该病的最佳治疗手段,术前准确定位有助于缩小探查范围及减少手术并发症。【Objective】To summarize the experience in diagnosis and managements for primary hyperparathyroidism（PHPT）. 【Methods】The clinical data of 17 patients with PHPT who underwent parathyroidectomy in our hospital from Sept.2001 to Mar. 2013 were analyzed retrospectively. 【Results】There were 1 case of hyperplasia（5.88%）, 16 cases of adenoma（94.12%） among the 17 cases of PHPT. The common presentations involved with osteoporosis in 15 cases, pain in bones and joints in 7 cases, pathologic fractures in 5 cases, urinary calculi in 4 cases, deformity in bones and joints in 7 cases, fatigue and anergy in 4 cases and absence of symptoms in one case. The preoperative calcium, serum alkaline phosphatase, parathyroid hormone were increased in all 17cases. The serum calcium was up to 3.56 mmol/L, mean was 2.68 mmol/L. serum PTH was up to 2500 pg/mL, the average was 677.8 pg/mL. serum ALP was up to 2 604.4 U/L, mean was 1 220 U/L. And serum minimum phosphorus was 0.41 mmol/L, mean was 0.69 mmol/L. The parathyroid lesions were showed through B-ultrasound and CT examination in 16 cases, but the other one case showed no lesions through B-ultrasound and CT examination, and 99 mTc check found mediastinal parathyroid radionuclide uptake. The neck low incision exploratory surgery wasperformed in 16 cases. Unilateral exploration in 15 cases with parathyroid adenoma, bilateral exploration excision in one case with parathyroid hyperplasia. Thoracotomy and adenoma resection was performed in the one case because of the mediastinal parathyroid tumors. The postoperative tetany were occurred in 6 cases. All patients in this group were followed up from 9 months to 13 years. The patient with parathyroid hyperplasia lost to follow-up. 16 cases were followed up so far no recurrence, and no postoperative deaths. Orthopedic surgery were performed in 4 cases with bone and joint deformity in 6 months to one year after parathyroidectomy. Lithotripsy or lithotomy were accepted in 4 cases of urinary tract stones.【Conclusions】It w

关 键 词：原发性甲状旁腺功能亢进症 诊断 甲状旁腺切除术 肿瘤 内分泌腺瘤病 

分 类 号：R582.1[医药卫生—内分泌]