原发性甲状旁腺功能亢进症合并甲状腺癌病例分析  

Surgical management of primary hyperthyroidism and coexistent thyroid carcinoma

作　　者：申虹[1] 魏伯俊[1] 谢洪[1] 彭振兴[1] 王佳[1] 白娟[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院耳鼻咽喉头颈外科首都医科大学耳鼻咽喉头颈外科重点实验室教育部重点实验室,100038

出　　处：《中华耳鼻咽喉头颈外科杂志》2016年第4期273-276,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的 总结分析原发性甲状旁腺功能亢进症合并分化型甲状腺癌的诊疗结果及其影响因素.方法 回顾总结2007年3月--2014年5月,北京世纪坛医院耳鼻咽喉头颈外科27例原发性甲状旁腺功能亢进症合并甲状腺癌患者的临床表现及其不同手术方式的结果.其中男10例,女17例,年龄25～73岁,平均49岁.甲状腺乳头状癌23例,滤泡状癌1例,髓样癌3例.甲状旁腺瘤24例,甲状旁腺癌2例,甲状旁腺增生1例.非同期手术者8例,其中7例在行甲状腺癌手术时已存在高钙血（2.7～3.1mmol/L）,在甲状腺癌术后3～ 26个月实施甲状旁腺手术,1例甲状旁腺癌术后复发合并甲状腺癌.19例原发性甲状旁腺功能亢进症患者同期实施甲状旁腺和甲状腺癌手术,在实施甲状旁腺手术时常规术中快速检测外周血甲状旁腺激素动态变化,甲状旁腺手术标本切除5分钟后甲状旁腺激素降幅均不低于50％.结果 术后暂时性甲状旁腺功能低下者26例,长期性甲状旁腺功能低下者4例,均发生于分次手术者.暂时性喉返神经不全麻痹者4例.无新发永久性喉返神经麻痹者.随访11 ～43个月均未见甲状腺癌或甲状旁腺功能亢进症复发.结论 原发性甲状旁腺功能亢进症合并甲状腺癌患者一期手术可降低术后长期性甲状旁腺功能低下风险,甲状腺癌患者术前应尽可能检查血钙和甲状旁腺激素.Objective To evaluated the results of surgical treatment for primary hyperparathyroidism coexistent with thyroid cancer.Methods From March 2007 to May 2014,27 patients suffered thyroid carcinoma coexistent with primary hyperparathyroidism with pathological and laboratory confirmation were studied retrospectively.In 8 of 27 cases thyroidectomy and parathyroidectomy were performed separately,with interval time of 3 to 26 months,and in the remaining cases both procedures were done simultaneously.During surgery quick PTH evaluation and calcium measure were routinely performed.Results Postoperative temporary hypoparathyroidism was found in 26 of 27 cases,and postoperative permanent hypoparathyroidism developed in 4 cases that underwent separate operation.Limited movement of vocal cord was showed in 4 cases after parathyroidectomy,but it lasted no more than 2 months.No permanent paralysis of recurrent laryngeal nerve was found.No thyroid cancer or hyperparathyroidism was found with follows-up of 11 to 43 months.Conclusions Thyroidectomy and parathyroidectomy performed separately have higher risk to develop hypoparathyroidism than they are done simultaneously.PTH and calcium should be evaluated in patients with thyroid carcinoma whenever available.

关 键 词：甲状旁腺功能亢进症 甲状腺肿瘤 外科手术 

分 类 号：R582.1[医药卫生—内分泌]