原发性甲状旁腺腺瘤273例临床分析  

Clinical analysis of primary parathyroid adenomas:a report of 273 cases

作　　者：黄晓天[1] 张永侠 马冰[1] 邹贵军[1] 赵建东[2] 纵亮[2] 杜晓辉[1] 刘明波[2] Huang Xiaotian;Zhang Yongxia;Ma Bing;Zou Guijun;Zhao Jiandong;Zong Liang;Du Xiaohui;Liu Mingbo(College of General Surgery,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;College of Otolaryngology Head and Neck Surgery,the Sixth Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心普通外科医学部,北京100853 [2]解放军总医院第六医学中心耳鼻咽喉头颈外科医学部,北京100853

出　　处：《中华解剖与临床杂志》2023年第11期731-735,共5页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨原发性甲状旁腺腺瘤的临床特征和诊疗方法。方法横断面研究。纳入解放军总医院第一医学中心普通外科和解放军总医院第六医学中心耳鼻咽喉头颈外科2005年12月—2020年12月经手术和病理检查确诊的原发性甲状旁腺腺瘤273例,其中男90例、女183例,年龄15~78(50.7±13.5)岁,病程0.2~216.0(20.8±34.3)个月。患者均行微创甲状旁腺切除术。观察患者的临床表现、影像学检查结果、手术前后主要生化指标变化、手术及随访结果(肿瘤部位、并发症、复发情况等)。结果(1)临床表现:273例患者中,118例(43.2%)患者无临床症状;其余155例(56.8%)患者主要表现为胸腹痛、腰背痛、全身骨痛、肌痛、关节痛、上下肢痛等,无特异性表现。(2)影像学检查结果:术前甲状腺超声检查,结果异常者占99.2%(256/258);放射性核素显像检查,甲状旁腺放射性异常浓聚者占94.5%(172/182);颈部及腹部CT检查,甲状腺及甲状旁腺肿物和泌尿系结石者占94.1%(128/136);颈部MR检查,甲状腺及甲状旁腺肿物者占92.9%(13/14);颅骨、四肢骨、脊柱骨和骨盆骨X线检查,骨质病变者占83.9%(52/62);骨密度检查,骨质疏松者占84.6%(33/39)。(3)生化指标变化:术后患者血钙、血磷、甲状旁腺激素指标均较术前改善,差异均有统计学意义(P值均<0.001);手术前后碱性磷酸酶差异无统计学意义(P>0.05)。(4)手术及随访结果:273例患者手术均成功。术中确定肿瘤部位,甲状腺左、右叶外下各占34.4%(94/273),甲状腺左、右叶外上分别占9.5%(26/273)和12.5%(34/273),其他9.2%(25/273)。术后24 h出现低钙症状36例。术后189例患者获随访1~13(6.3±2.4)年,其中,因低钙麻木、抽搐7例,声嘶、呛咳5例,腺瘤复发3例,7例死于其他疾病,其余患者无症状、无瘤生存。结论原发性甲状旁腺腺瘤临床表现无特异性,超过40%患者无症状,可经影像学检查和实验室检验确诊;其主要治疗方式�Objective This study aimed to explore the clinical characteristics,diagnosis,and treatment of primary parathyroid adenomas(PPTAs).Methods A total of 273 patients with PPTAs confirmed by surgery and pathology in the Department of General Surgery and Otorhinolaryngology Head and Neck Surgery of PLA General Hospitalfrom from December 2005 to December 2020 were analyzed retrospectively.Of the 273 patients,90 were male and 183 were female aged 15 to 78(50.7±13.5)years.Their disease duration ranged from 0.2 to 216.0(20.8±34.3)months.The tumors of all patients were removed by minimally invasive parathyroidectomy.In addition,the clinical symptoms and signs,imaging features,primary serum biochemicals before and after surgery,operation,and prognosis were observed.Results(1)A total of 118 patients(43.2%)were asymptomatic,and the other 155 patients(56.8%)reported chest and abdominal pain,low back pain,systemic bone pain,myalgia,arthralgia,upper and lower limb pain,etc.(2)Radiological examintion showed that 99.2%(256/258)of patients had abnormal results as confirmed by pre-operative thyroid ultrasound check;94.5%(172/182)of patients had an abnormal concentration of radioactive substances in parathyroid radiation as confirmed by scintigraphy;94.1%(128/136)of patients had thyroid and parathyroid masses and urinary tract stones as confirmed by CT scans;92.9%(13/14)of patients had thyroid and parathyroid masses as shown in MRI,and 83.9%(52/62)of patients showed skull,limb bones,spine bones,and pelvic bones by X-ray,and 84.6%(33/39)showed osteoporosis by bone density testing.(3)The serum calcium and phosphorusand parathyroid hormone of patients after surgery improved significantly compared with those before surgery(all P values<0.001),but serum alkaline phosphatase showed no significant difference before and after operation(P>0.05).(4)All 273 patients underwent surgery successfully.The location of the tumor site was determined during surgery,with 34.4%(94/273)on the right and left lobes lateral and inferior to the thyroid gland,

关 键 词：甲状旁腺肿瘤 原发性甲状旁腺腺瘤 原发性甲状旁腺功能亢进 微创甲状旁腺切除术 

分 类 号：R736.2[医药卫生—肿瘤]