原发性甲状旁腺功能亢进症115例诊治分析  

Diagnosis and treatment of primary hyperparathyroidism： 115 cases

作　　者：童传明 郑荆州 吴高松[3] 

机构地区：[1]武汉市东西湖区人民医院甲乳外科,430040 [2]湖北民族学院附属民大医院普外二科,湖北恩施445000 [3]华中科技大学同济医学院附属同济医院甲乳外科,武汉430030

出　　处：《中华内分泌外科杂志》2016年第1期45-48,共4页Chinese Journal of Endocrine Surgery

基　　金：湖北省自然科学基金（2008CDB179）

摘　　要：目的分析原发性甲状旁腺功能亢进症（primary hyperparathyroidism，PHPT）的临床特点，探讨其诊断及手术治疗。方法回顾分析2006年1月至2014年3月武汉同济医院、武汉东西湖区人民医院和湖北民族学院附属民大医院甲乳外科收治的115例首次手术并经病理确诊的PHET诊治经验。结果PH胛的临床表现多样性，误（漏）诊率较高，达70．0％（77／115）。超声检查的阳性检出率为61．0％（64／105）．0‰m．MIBI检查的阳性检出率为88．3％（68／77），CT检查的阳性检出率为75．4％（46／61），3者比较，差异有统计学意义（P〈0．05）。89例定位准确的甲状旁腺腺瘤均行单侧探查，6例甲状旁腺增生行双侧探查，3例甲状旁腺癌行甲状旁腺癌切除＋患侧甲状腺叶切除＋患侧中央区淋巴结清扫术，21例合并甲状腺良恶性病变同时行相应手术。手术后97例发生不同程度的低钙血症，应用钙剂后症状缓解。结论PHFF定性诊断主要依据血清甲状旁腺素（parathyroid hormone，PTH）及钙浓度的升高，定位诊断主要依靠^99Tc^m-MIBI和超声检查，一旦明确诊断应手术治疗。定位明确的甲状旁腺腺瘤可行单侧探查。Objective To analyze clinical features of primary hyperparathyroidism（PHPT）and to evaluate the diagnosis and treatment for PHPT. Methods 115 patients with PHPT undergoing surgery and confirmed by pathology from Jan. 2006 to Mar. 2014 were retrospectively analyzed. Results The clinical manifestations of PHPT were various. The rate of misdiagnosis was 70.0%（77/115）. The positive rate of uhrasonography was 61.0% （64/105）, ^99Tc^m-MIBI 88.3%（68/77）and CT 75.4%（46/61 ）, respectively. The difference among the 3 tested meth- ods had statistical significance （P〈0.05）. 89 cases with parathyroidoma underwent unilateral neck exploration, 6 cases of parathyroid hyperplasia underwent bilateral neck exploration, 3 cases with parathyroid carcinoma under- went carcinoma resection, ipsilateral thyroid lobe resection and ipsilateral central lymph node dissection, and 21 cases with thyroid benign or malignant lesions underwent suitable operations. 97 cases developed hypocalcaemia of various degrees after operation, and the symptoms were relieved after use of calcium gluconate. Conclusions PHPT can be diagnosed according to the lever of serum calcium and PTH. Uhrasonography and ~grcm-MIBI should be the first choice for preoperative localization. Unilateral neck exploration can be used for parathyroidoma with accurate localization.

关 键 词：原发性甲状旁腺功能亢进 甲状旁腺肿瘤 

分 类 号：R582.1[医药卫生—内分泌]