摘要
目的探讨甲状旁腺肿瘤的诊断和外科治疗方法。方法回顾性分析近5年余中山大学附属第三医院手术确诊、年龄11～71岁的12例甲状旁腺肿瘤临床资料。包括甲状旁腺癌并甲状腺肿及多发性内分泌腺瘤I型（MEN-1）1例；甲状旁腺囊肿1例；甲状旁腺瘤10例，其中1例为双侧甲状旁腺瘤并MEN-1，1例合并甲状腺肿，1例为异位腺瘤。结果依靠血钙、血磷、B超、CT及99mTc-MIBI等检查10例在术前确诊（2例术后确诊）。8例腺瘤和1例囊肿行单侧探查及甲状旁腺瘤切除；行双侧探查3例，其中1例甲状旁腺瘤并甲状腺肿行双侧甲状腺大部分切除（包括旁腺瘤），1例甲状旁腺癌为MEN-1行根治性切除及切除垂体肿瘤手术，1例甲状旁腺瘤并MEN-1术前行胰岛素瘤和肾上腺皮质瘤切除。平均随访时间38个月。随访期间11例血钙正常，8例无症状生存；1例腺瘤术后对侧甲状旁腺增生，再次手术。结论定位明确的单发甲状旁腺瘤或囊肿可单侧探查，MEN-1和腺癌或伴结节甲状腺肿者应双侧探查。术后密切随访不仅可确定手术效果，而且有利于早期发现复发患者和MEN-I患者。
Objective To explore the diagnosis and surgical treatment of primary parathyroid tumor （ PIT ）. Methods The clinical data of 1 2 patients with primary parathyroid tumor and treated by operation were analyzed retrospectively. In this group, 1 patient with parathyroid carcinoma complicated with goiter and was diagnosed as MEN - I ; 1 case with parathyroid cyst ; 1 0 cases with parathyroid adenoma （ PTA ） , one of which was complicated with goiter, and one MEN-1 case with bilateral parathyroid adenoma, and 1 was ectopic PTA. Results The diagnosis were made before operation based on the result of blood calcium and phosphorous, B-type ultrasound, CT and 99mTc-MIBI in 10 cases. Unilateral neck exploration （UNE） was performed in 8 cases with parathyroid adenoma and in 1 case with parathyroid cyst ; the case of parathyroid carcinoma with MEN-1 and the MEN-1 case of parathyroid adenoma with goiter had bilateral neck exploration （ BNE ） and the case with parathyroid carcinoma underwent radical operation. All of the cases were followed up for average 3 8 months. In the followup time, the level of serum calcium was normal in 1 1 cases and 8 patients were asymptomatic ; only 1 case with parathyroid adenoma who underwent UNE developed parathyroid hyperplasia in the opposite side, and was cured by re-operation. Conclusions UNE for single parathyroid adenoma or cyst is feasible, if accurate image localizations is available; the cases with parathyroid carcinoma or parathyroid adenoma with goiter or MEN- I should undergo BNE. By close follow up of the cases, the effect of surgical treatment can be determined, and also has the advantage of early find of cases with recurrence or with MEN-1.
出处
《中国普通外科杂志》
CAS
CSCD
2008年第5期415-418,共4页
China Journal of General Surgery
