肾结石为首要症状的原发性甲状旁腺功能亢进症1例报告及文献复习  

A case report and literature review of primary hyperparathyroidism with renal calculi as the first symptom

作　　者：何永茂 邵命海[1] 兰天鹰 王琛 叶朝阳 HE Yongmao;SHAO Minghai;LAN Tianying;WANG Chen;YE Chaoyang(Department of Nephrology,Shuguang Hospiatl Affiliated to Shanghai University of Traditional Chinese Medicine,Shanhai201203,China;Institute of Traditional Chinese Medicine Nephropathy,Shanghai University of Traditional Chinese Medicine,Shanhai201203,China;Shanghai Key Laboratory of Traditional Chinese Clinical Medicine,Shanhai201203,China;Key Laboratory of Liver and Kidney Diseases(Shanghai University of Traditional Chinese Medicine),Ministry of Education,Shanghai201203,China)

机构地区：[1]上海中医药大学附属曙光医院肾病科,上海201203 [2]上海中医药大学中医肾病研究所,上海201203 [3]上海市中医临床重点实验室,上海201203 [4]肝肾疾病病证教育部重点实验室(上海中医药大学),上海201203

出　　处：《中国医药导报》2022年第33期184-187,共4页China Medical Herald

基　　金：国家自然科学基金资助项目(81973807)。

摘　　要：本文报告1例以肾结石为主要症状的原发性甲状旁腺功能亢进症(PHPT)患者,本例患者曾有口干多饮、多尿20余年病史,未得到正确诊治。本例患者主要表现为腰痛,腹胀,恶心呕吐,肉眼血尿等肾结石梗阻症状,行左侧甲状旁腺切除术后,病理明确诊断为PHPT。经激光碎石、药物治疗、甲状旁腺腺瘤切除等诊治后,血钙、尿检和肾功能恢复,残余双肾小结石,术后甲状旁腺素(PTH)仍升高,至术后2个月恢复正常。目前继续随访肾脏、甲状旁腺影像学,以及肾功能,血钙、PTH和尿钙水平。PHPT诊断包括定性、定位诊断,实验室检查作出定性诊断,影像学检查用于定位及定量。治疗方面,内科治疗可缓解高钙血症急症,手术治疗是PHPT彻底治愈的首选方法;根据患者病变的部位及数量选择术式;术中PTH监测有利于提高治愈率;术后随访PTH和血钙,患者PTH仍升高应首先考虑继发性甲状旁腺功能亢进,并排除手术不全或复发的可能。This paper reports a case of primary hyperparathyroidism(PHPT) with kidney calculi as the main symptom. This patient had a history of dry mouth polydipsia and polyuria for more than 20 years, which was not properly diagnosed and treated. In this case, the main symptoms of renal stone obstruction were low back pain, abdominal distension, nausea and vomiting, gross hematuria, etc. After lefe parathyroidectomy, PHPT was clearly diagnosed by pathology. After laser lithotripsy,drug therapy, and parathyroid adenoma resection, blood calcium, urine and renal function were recovered, small calculi were left in both kidneys, and parathyroid hormone(PTH) was still elevated after operation, and returned to normal two months after operation. Renal and parathyroid imaging, renal function, serum calcium, PTH, and urinary calcium levels were followed up.The diagnosis of PHPT includes qualitative and locational diagnosis, laboratory examination makes qualitative diagnosis, and imaging examination is used for localization and quantification. In terms of treatment, medical treatment can alleviate the hypercalcemia emergency, and surgical treatment is the first choice for the complete cure of PHPT, the surgical method was selected according to the location and number of lesions, intraoperative PTH monitoring is beneficial to improve the cure rate, if PTH and serum calcium are still elevated during postoperative follow-up, secondary hyperparathyroidism should be considered first, and the possibility of incomplete surgery or recurrence should be excluded.

关 键 词：原发性甲状旁腺机能亢进 甲状旁腺腺瘤 高钙血症 肾结石 

分 类 号：R5[医药卫生—内科学]