36例难治性继发性甲状旁腺功能亢进症的甲状旁腺彩色多普勒超声分析

目的 探讨彩色多普勒高频超声在慢性肾功能衰竭继发甲状旁腺功能亢进症（secondary hyperparathyroidism,SHPT）中的应用价值.方法 分析36例经手术、病理证实的甲状旁腺增生结节120枚彩色多普勒超声声像图特点. 结果 36例患者手术共切除甲状旁腺、甲状腺结节及部分胸腺组织134枚,病理诊断：甲状旁腺增生120枚,14枚非甲状旁腺腺体增生.120枚增生的甲状旁腺腺体有3枚异位在胸腺组织内,1枚异位在甲状腺内;有3例合并甲状腺癌,发病率8.3％（3/36）.超声报告甲状旁腺增大或增生84枚,最大2.6cm×1.6cm×1.5cm,最小0.30cm×0.27cm×0.21cm,与病理诊断符合81枚,符合率96.4 ％（81/84）.阳性率67.5 ％（81/120）,漏诊腺体39枚,假阴性率32.5 ％（39/120）.误诊为甲状旁腺3枚,3枚分别是甲状腺下级的淋巴结1枚、甲状腺结节2枚,假阳性率3.6 ％（3/84）.结论 彩色多普勒超声可作为甲状旁腺增生的首选检查手段、并可作为术前定位、继发性甲旁亢患者甲状腺癌诊断的重要依据.

Color Doppler ultrasonography for parathyroid hyperplasia in 36 cases with refractory secondary hyperparathyroidism

Objective To investigate the clinical value of high-frequency color Doppler ultrasonography in secondary hyperparathyroidism following chronic renal failure.Methods Ultrasonographic characteristics of hyperplastic parathyroid nodules confirmed by pathology after surgery were retrospectively analyzed in 36 patients.Results A total of 134 clinically diagnosed hyperplastic parathyroid nodules were surgically removed from 36 patients.In these surgical samples,pathological examination confirmed to be hyperplastic parathyroid nodules in 120 samples,and non-parathyroid hyperplasia （including thyroid nodules and ectopic thymus） in 14 samples.In the 120 samples of hyperplastic parathyroid nodules,ectopic parathyroid located in thymus in 3 samples and in thyroid in one sample.Hyperplastic parathyroid nodules complicated with thyroid carcinoma was found in 3 cases （3/36,8.3％）.Ultrasonography detected 84 nodules of parathyroid enlargement or hyperplasia （maximal size of 2.6 cm x 1.6 cm x 1.5 cm and minimal size of 0.30 cm x 0.27 cm x 0.21 cm）,in which 81 samples （96.4％） had the same diagnosis by pathological examination,with the rate of correct diagnosis of 67.5％ （81/120）,and the rate of missed nodules of 32.5％ （39/120）.Misdiagnosed nodules by ultrasonography occurred in 3 samples including lymph node in the lower pole of thyroid in one sample and thyroid nodule in 2 samples,with the rate of misdiagnosis of 3.6％ （3/84）.Conclusion High-frequency color Doppler ultrasonography can be used as the preferred screening method for the diagnosis and localization of parathyroid hyperplasia before surgery,and for the diagnosis of secondary hyperparathyroidism complicated with thyroid carcinoma.