甲状旁腺癌5例的诊断和治疗  

Diagnosis and treatment of 5 cases with parathyroid carcinoma

作　　者：虞同华[1] 朱岩[2] 刘方舟[1] 

机构地区：[1]江苏省肿瘤医院头颈外科,210009 [2]南京医科大学第一附属医院病理科

出　　处：《江苏医药》2014年第19期2273-2275,共3页Jiangsu Medical Journal

摘　　要：目的总结5例甲状旁腺癌(PTC)的诊治经验。方法回顾性分析5例PTC患者的临床资料。结果 5例均有原发性甲状旁腺功能亢进症的表现,4例有高钙血症,3例血甲状旁腺素(PTH)升高达正常上限的2倍以上。5例均经常规病理及免疫组化确诊。1例行甲状旁腺切除术+患侧甲状腺全切除术+Ⅵ区淋巴清扫术,4例行甲状旁腺肿瘤残留灶切除+患侧甲状腺全切除术+同侧颈淋巴清扫术(Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ区)。随访1-7年,4例复发。2例PTC伴多发性骨转移和颈淋巴结转移及1例PTC伴颈淋巴结转移患者,术后再次手术行颈部淋巴清扫并颈部放射治疗;1例PTC伴颈淋巴结转移患者,术后再次手术行颈部淋巴清扫并颈部放射治疗,2年后发现肺部转移,行γ刀治疗。结论术前血钙、PTH、超声和CT检查有利于明确PTC诊断。手术方式以甲状旁腺切除术+患侧甲状腺全切除术+同侧颈淋巴清扫术为宜。Objective To summarize the experience in the diagnosis and treatment of 5 cases with parathyroid earcinoma（PTC）. Methods Data of 5 cases of PTC were retrospectively analyzed. Results Five patients were with the manifestations of primary hyperparathyroidism,of whom 4 cases occurred hypercalcemia and 3 cases had a high level of parathyroid hormone（PTH） that was over two folds of the normal upper limit. The PTC in 5 cases was confirmed by routine histopathology and immunohistochemistry. Parathyroidectomy combined with ipsilateral total thyroidectomy and neck dissection in level Ⅵ were performed in 1 patient, and parathyroidectomy including residual tumor combined with ipsilateral total thyroidectomy and neck dissection in levels of Ⅱ, Ⅲ, Ⅳ, Ⅴ and gl were performed in 4 patients. PTC recurred in 4 cases during 1 to 7 years of follow-up. The ipsilateral neck dissection again plus radical therapy after surgery was performed in 2 cases with multiple bone metastasis and neck lymph node metastasis and in 1 case with neck lymph node metastasis. Another 1 case with neck lymph node metastasis occurred lung metastasis in 2 years after ipsilateral neck dissection plus radical therapy and accepted the treatment of 7-knife. Conclusion Routine blood calcium examination, blood PTH determination, ultrasonography and CT are helpful in diagnosing PTC before operation. The appropriate surgical procedure is parathyroidectomy combined with ipsilateral total thyroidectomy and neck dissection in levels of Ⅱ, Ⅲ, Ⅳ, Ⅴ and Ⅵ.

关 键 词：甲状旁腺癌 

分 类 号：R736[医药卫生—肿瘤]