摘要
目的总结原发性甲状旁腺功能亢进症的诊治体会。方法回顾性分析2003年1月至2010年12月期间笔者所在医院施行手术治疗的73例原发性甲状旁腺功能亢进症患者的临床资料。结果 73例原发性甲状旁腺功能亢进症患者中,腺体增生1例(1.4%),腺瘤67例(91.8%),腺癌5例(6.8%)。临床表现包括骨和关节疼痛63例(86.3%)、病理性骨折17例(23.3%)、骨质疏松59例(80.8%)、乏力28例(38.4%)、腹痛4例(5.5%)、泌尿系统结石17例(23.3%)、恶性高血压1例(1.4%,为多发性内分泌腺瘤病Ⅱa型)等。术前所有患者的全段甲状旁腺激素水平均升高,有80.8%(59/73)的患者血钙水平升高,有84.9%(62/73)的患者碱性磷酸酶水平升高。病灶检出率彩超为82.8%(53/64),CT检查为83.3%(20/24),99Tcm-司他比锝(MIBI)核素扫描为90.2%(46/51),三者联合检查为91.8%(67/73),余6例病灶术前未能明确定位。所有病例均行患侧甲状旁腺切除术,5例腺癌病例加行颈淋巴结清扫术。术后发生手足抽搐16例,声音嘶哑2例,急性胰腺炎1例,急性左心功能衰竭1例。术后69例患者获访,随访时间3～72个月,平均17.3个月。随访期间,大部分病例于术后1个月内其骨痛(43例)和乏力(18例)症状改善,但甲状旁腺激素和血钙水平的恢复则相对缓慢。1例腺瘤病例术后复发,1例腺癌病例术后发生肺转移,1例腺癌病例于术后37个月因肺和骨转移死亡,其余患者(1例腺癌病例由腺瘤恶变而来,行再次手术)至随访结束时均存活,无复发及转移。结论应深入理解和认识原发性甲状旁腺功能亢进症的临床特点,甲状旁腺功能和血钙水平的筛查有助于该病的检出。甲状旁腺切除术是该病的有效治疗手段,术前准确定位有助于缩小探查范围。
Objective To summary the experience in diagnosis and managements for primary hyperparathyroidism（PHPT）.Methods The clinical data of 73 patients with PHPT who underwent parathyroidectomy in our hospital from Jan.2003 to Dec.2010 were analyzed retrospectively.Results There were 1 case of hyperplasia（1.4%）,67 cases of adenoma（91.8%）,and 5 cases of adenocarcinoma（6.8%）among the 73 cases of PHPT.The common presentations involved with pain in bones and joints in 63 cases（86.3%）,pathologic fractures in 17 cases（23.3%）,osteoporosis in 59 cases（80.8%）,fatigue in 28 cases（38.4%）,abdominal pain in 4 cases（5.5%）,urolithiasis in 17 cases（23.3%）,malignant hypertension in 1 case（1.4%）who suffered multi-endocrine neoplasm（MEN）Ⅱa,and so on.The preoperative serum parathyroid hormone（PTH）abnormally elevated in all 73 patients,and serum calcium abnormally elevated in 59 patients（80.8%）,and alkaline phosphatase abnormally elevated in 62 patients（84.9%）before operation.The positive rate of lesion locations by ultrasonography,CT,99Tcm-sestamibi（MIBI）scan,and the combination of 3 kinds of tests were 82.8%（53/64）,83.3%（20/24）,90.2%（46/51）,and 91.8%（67/73）respectively,but 6 cases were not traced preoperatively.Parathyroidectomy was conducted to all the cases,besides,regional neck lymphadenectomy was performed for those 5 adenocarcinoma cases.Tetany in 16 cases,hoarseness in 2 cases,acute pancreatitis in 1 case,acute left heart failure in 1 case were observed after operation.Sixty nine cases were follow-up for 3-72 months（average 17.3 months）.During the followed-up period,most of them were alleviated from bone pain（43 cases）and fatigue（18 cases） within 1 month.However,the recovery of PTH and serum calcium back to normality were relatively slow.One case of adenoma recurred,1 case of adenocarcinoma suffered lung metastasis,1 case of adenocarcinoma survived for 37 months prior to death for postoperative lung and bone metastasis,the other cases（including 1 case of adenocarcinoma developed from adenoma）were still alive and had no metastasis or recurrence by the end of follow-up.Conclusions The symptoms of PHPT vary and lack of specificity,hence,the enhancement of knowledge to this disease and screenings conducted for parathyroid function and serum calcium will increase the rate of diagnosis.Parathyroidectomy is the effective management for PHPT,and preoperatively accurate position contribute to minimal exploration.
出处
《中国普外基础与临床杂志》
CAS
2013年第7期776-781,共6页
Chinese Journal of Bases and Clinics In General Surgery
