27例原发性甲状旁腺功能亢进症的诊治分析  

Diagnosis and treatment of 27 cases of primary hyperparathyroidism

作　　者：杜银娟 黄志纯[1] 王丽芬[1] 冯旭[1] DU Yinjuan;HUANG Zhichun;WANG Lifen;FENG Xu(Department of Otolaryngology Head and Neck Surgery,Zhongda Hospital,Southeast University,Nanjing,Jiangsu,210009,China)

机构地区：[1]东南大学附属中大医院耳鼻咽喉头颈外科,江苏南京210009

出　　处：《中国耳鼻咽喉头颈外科》2024年第10期620-625,共6页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)的临床特点及诊治方法,提高诊疗能力。方法回顾性分析东南大学附属中大医院2016年1月~2023年6月收治的27例PHPT患者的临床资料,对临床特点、术前诊断、外科治疗方式及术后随访情况进行归纳总结。结果所有患者术前血钙和甲状旁腺素(PTH)升高,均于术前确诊。27例患者均行颈部低位切口甲状旁腺探查手术,19例行单侧甲状旁腺切除,8例行双侧切除。术中切除病变腺体后10 min快速检测PTH,27例均在PTH下降50%以上后终止手术。所有患者术后均无声嘶、饮食呛咳等并发症。术后病理诊断甲状旁腺腺瘤20例,甲状旁腺增生7例。术后15例患者出现短期低血钙,经骨化三醇和钙剂治疗2~4周均改善,血钙恢复正常。1例略高于正常值,术后1周左右血钙恢复正常。余患者术后血钙正常。术后27例患者PTH在6个月内恢复至正常水平。结论甲状旁腺切除术是PHPT的最佳治疗手段,术前影像学定位、术中PTH检测,有助于缩小探查范围,缩短手术时间,减少手术并发症等。OBJECTIVE To explore the clinical characteristics,diagnosis and treatment of primary hyperparathyroidism(PHPT),and to improve the diagnosis and treatment ability of this disease.METHODS The clinical data of 27 patients with PHPT admitted to Southeast University Affiliated Zhongda Hospital from January 2016 to June 2023 were retrospectively analyzed,and the clinical characteristics,preoperative diagnosis,surgical treatment and postoperative follow-up were summarized.RESULTS All patients had elevated serum calcium and parathyroid hormone before operation,and were diagnosed before operation.All patients underwent parathyroidectomy with low neck incision,19 underwent unilateral parathyroidectomy and 8 underwent bilateral parathyroidectomy.PTH was rapidly detected 10 min after resection of the diseased gland,all 27 cases terminated surgery after PTH decreased by more than 50%.All patients experienced no postoperative complications such as hoarseness and coughing due to diet.There were 20 cases diagnosed pathologically as parathyroid adenoma and 7 cases diagnosed as parathyroid hyperplasia after operation.After operation,15 patients had short-term hypocalcemia,the hypocalcemia patients were treated with calcitriol and calcium for 2-4 weeks and their blood calcium returned to normal.and one patient was slightly higher than normal value,the hypercalcemia returned to normal about one week after operation.The remaining patients had normal serum calcium after operation.The parathyroid hormone returned to normal in 27 patients within 6 months.All patients were followed up for 6 months to 6 years,and no one recurred.CONCLUSION Parathyroidectomy is the best treatment for PHPT.Preoperative imaging location and intraoperative PTH measurement are helpful to narrow the exploration range,shorten the operation time and reduce the complications.

关 键 词：甲状旁腺功能亢进 原发性 外科手术 术前定位 

分 类 号：R581.1[医药卫生—内分泌]