摘要
目的探讨和总结原发性甲状旁腺功能亢进(PHPT)症的诊断和治疗方法。方法回顾性总结49例PHPT的临床资料。结果甲状旁腺腺瘤44例,甲状旁腺增生2例,甲状旁腺癌3例。术前49例患者平均血钙浓度3.31 mmol/L,平均甲状旁腺素(PTH)浓度97.98 pmol/L,99Tcm-MIBI扫描准确定位46例甲状旁腺病变,颈部彩超准确定位40例甲状旁腺病变。45例行单侧颈部探查术(单发甲状旁腺腺瘤42例,其中包括异位甲状旁腺腺瘤1例,甲状旁腺癌3例);4例行双侧颈部探查术(双侧甲状旁腺腺瘤2例,甲状旁腺增生2例);3例甲状旁腺癌中,2例同时行甲状旁腺肿瘤和同侧甲状腺腺叶切除,1例仅行甲状旁腺肿瘤切除。术后43例得到随访,时间4个月至8年。其中42例(38例腺瘤,2例增生,2例癌)术后无复发;1例癌于术后8个月局部复发行患侧甲状腺切除,后无复发。结论高浓度血钙、PTH及骨骼或泌尿系统症状是PHPT定性诊断的重要依据,99Tcm-MIBI扫描及超声是病变定位的良好手段,手术治疗是最有效的方法,单侧颈部探查术是常用的手术方式,但还应根据具体情况合理选择。
Objective To summarize and investigate the diagnosis and treatment of primary hyperparathyroidism（PHPT）.Methods The clinical date of 49 patients with PHPT were retrospectively studied.Results Parathyroid adenoma was diagnosed in 44 cases,parathyroid hyperplasia in 2 cases and parathyroid carcinoma in 3 cases.The mean calcium level was 3.31 mmol/L,the mean parathyroid hormone level was 97.98 pmol/L.Parathyroid disease was accurately localized by 99Tcm-MIBI scintigraphy in 46 cases and by ultrasonograph in 40 cases.Unilateral neck exploration were performed in 42 cases with solitary parathyroid adenoma and 3 cases of carcinoma.Bilateral neck exploration in 2 cases with multiple adenoma and 2 cases with parathyroid hyperplasia.Parathyroidectomy and ipsilateral thyroidectomy was performed in 2 cases with carcinoma,and parathroidectomy was performed in 1 case.Forty-three cases were postoperatively followed up for 4 months to 8 years.42 cases survived without recurrence,1 case of carcinoma had local recurrence in postoperative 8 months.Conclusion High level of calcium and parathyroid hormone,and the manifestations of skeleton and urinary systems are key points to diagnosis of PHPT.99Tcm-MIBI scintigraphy and ultrasonograph are preferred methods for localization.Unilateral neck exploration is the common method,rational surgery strategy should be still chosen according to the individual condition.
出处
《重庆医学》
CAS
CSCD
北大核心
2011年第15期1496-1498,共3页
Chongqing medicine
