摘要
目的总结原发性甲状旁腺功能亢进症的诊治经验。方法回顾性分析1992年11月-2008年12月我院收治的91例原发性甲状旁腺功能亢进症（primary hyperparathyroidism，PHPT）的临床资料。结果91例患者中甲状旁腺腺瘤88例（96．7％），腺癌3例（3．3％）。血清钙和甲状旁腺素（PTH）均升高。主要表现为骨痛和泌尿系结石。术前B超、CT和ECT ^99mTc—MIBI定位准确率分别为83．5％（76／91）、60．9％（14／23）、98．6％（69／70）。全部病例均行甲状旁腺腺瘤切除术，1例腺癌另行甲状腺腺叶切除加中央区淋巴结清扫。一次手术成功率97．8％（89／91）。90例术后随访8个月至14年，87例腺瘤患者获得临床治愈，3例腺癌患者中2例复发，其中1例死亡。结论原发性甲状旁腺功能亢进症的诊断并不困难，患有慢性骨病、反复发作泌尿系结石、消化性溃疡的患者应作为此病疑诊对象，血钙检查应作为常规；术前影像学检查首选B超和ECT ^99mTc—MIBI；定位准确的甲状旁腺瘤采用腺瘤切除术是可行的。
Objective To summarize the experience on diagnosis and treatment of primary hyperparathyroidism（PHPT）. Methods Clinical data of 91 PHPT patients treated in Beijing Jishuitan Hospital from November 1992 to December 2008 were analyzed retrospectively. Results Among 91 PHPT cases ,88 were diagnosed as parathyroid adenoma （ 96. 7% ）, 3 were diagnosed as parathyroid carcinoma （3.3%）. Serum calcium and PTH levels increased in all cases. Main clinical manifestations were osteodynia and kidney stones. The accuracy rate of preoperative B-ultrasound,CT and ECT 99mTc -MIBI on location was 83.5% （76/91） ,60. 9% （ 14/23 ） and 98.6% （69/70） respectively. Parathyroidectomy was performed in all but one cases, in which parathyroid carcinoma was managed by ipsilateral hemithyroidectomy and modified neck dissection. The cure rate of primary operation was 97. 8% （ 89/91 ）. Ninety cases were followed-up from 8 months to 14 years postoperatively, 87 cases with parathyroid adenoma achieved complete remission, 2 with parathyroid carcinoma suffered from tumor recurrence and 1 died. Conclusion Patients with chronic bone diseases, repeatedly recurrent nephrolithiasis, peptic ulcer disease should be a suspect of PHPT. The routine examinations of serum ca]cium and phosphorus are to be conducted. Uhrasonography and ECT99mTc-MIBI should be considered as the methods of first choice for preoperative localization.
出处
《中华普通外科杂志》
CSCD
北大核心
2010年第4期281-283,共3页
Chinese Journal of General Surgery
关键词
原发性甲状旁腺功能亢进症
甲状旁腺肿瘤
诊断
外科手术
Hyperparathyroidism, primary
Parathyroid neoplasms
Diagnosis
Surgical procedures, operative
