甲状旁腺癌的诊断和治疗(附7例报道)  

Diagnosis and Treatment of Parathyroid Carcinoma: A Report of 7 Cases

作　　者：胡琳[1,2] 崔爱民[1,2] 柏楠[1,2] 赵景明[1,2] 张自琴[1,2] 

机构地区：[1]北京积水潭医院 [2]北京大学第四临床医学院普通外科,北京100096

出　　处：《中国普外基础与临床杂志》2015年第1期76-80,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨甲状旁腺癌的诊断和治疗特点。方法回顾性分析笔者所在医院1993年1月至2014年4月期间收治的7例甲状旁腺癌患者的临床资料。结果 7例均表现有甲状旁腺功能亢进症状,4例可触及颈部肿块。术前血钙水平2.35~4.98 mmol/L,平均值为3.07 mmol/L;甲状旁腺激素（PTH）水平78.4~2 061.7 pg/m L,平均值为1 181.5 pg/m L,较正常高值高17倍。1例首次手术在外院施行。6例首次手术在笔者所在医院施行,其中肿瘤位于左下甲状旁腺3例,右下甲状旁腺2例,右上甲状旁腺1例;1例行甲状旁腺肿瘤切除术,5例行甲状旁腺肿瘤切除＋同侧腺叶全切或部分切除术,其中1例加行中央区淋巴结清扫术。有3例术后肿瘤复发均行再手术,其中1例复发3次;2例死亡;其余5例生存至今,其中已生存5年者3例。结论综合临床表现、血钙和PTH水平、B超、99Tcm-甲氧基异丁基异腈（99Tcm-MIBI）甲状旁腺双时像扫描、术中异常发现以及病理学检查结果有助于正确诊断甲状旁腺癌。手术必须完整（en bloc）切除肿瘤,复发者可再手术治疗,需行长期随访。Objective To explore the diagnosis and treatment features of parathyroid carcinoma （PTC）. Methods The clinical data of 7 cases of parathyroid carcinoma treated from January 1993 to April 2014 were analyzed retrospectively. Results All of the 7 patients had symptoms of hyperparathyroidism. Four patients had palpable neck mass. The average serum calcium level of preoperation was 3.07 mmol/L （2.35-4.98 retool/L）. The average parathyroid hormone （PTH） level was 1 181.5 pg/mL （78.4-2 061.7 pg/mL）, which elevated 17 times the upper limit of normal. One case had operation in other hospital and six cases in Jishuitan hospital. The tumors located in the left inferior parathyroid gland in 3 cases, 2 cases of right lower parathyroid, and right superior parathyroid gland in 1 cases. One case underwent parathyroidectomy, para- thyroidectomy including ipsilateral thyroid lobe or part of it was performed in 5 cases. Of 5 cases, 1 case was added central compartment lymphadenectomy. Three cases of postoperative tumor recurrence underwent reoperation, of which 1 case recurred 3 times. Two cases died. The remining 5 had survived until now, had survived for 5 years in 3 cases. Conclusions A comprehensive approach with clinical presentation, serum calcium and PTH levels, B-ultrasonography, 99Tcm-MIBI, intraoperation aberrant findings, and histopathology offers help to accurate diagnosis of parathyroid carcinoma. Surgery is en bloc resection of the primary lesion. Recurrence needs reoperation, and long-term follow-up is advised.

关 键 词：甲状旁腺癌 诊断 治疗 

分 类 号：R736.2[医药卫生—肿瘤]