136例原发性甲状旁腺功能亢进的诊治体会

目的分析原发性甲状旁腺功能亢进症的临床特点、诊断和治疗方法。方法回顾性分析四川大学华西医院2004年1月至2012年12月期间初次手术治疗且资料完整的原发性甲状旁腺功能亢进患者的临床资料。结果136例甲状旁腺功能亢进患者中骨型52例（38，23％），肾型17例（12．50％），骨。肾型7例（5．15％），生化型24例（17．65％），合并其他临床表现者36例（26．47％）。术前甲状旁腺激素（parathyroid hormone，PTH）值为（106．20±88．88）pmol／L（6．91～390pmol／L），血钙值为（3．12±0．66）mmol／L（2．15～5．77mmol／L）。甲状腺及颈部淋巴结彩超和锝．甲氧基异丁基异腈放射性核素双时相显像（99Tcm-MIBI）定位诊断与手术发现符合率分别为75．00％及85．29％，联合CT检查三者符合率为86．76％。术后病理诊断：良性病变129例（94．85％），甲状旁腺癌7例（5．15％）。良性病变中甲状旁腺腺瘤119例（92．25％），其中单发114例（95．80％），多发腺瘤或甲状旁腺瘤合并甲状旁腺增生5例（4．20％）；甲状旁腺增生10例（7．75％），其中8例为甲状旁腺不典型增生或增生活跃。124例（91．18％）患者术后3d内PTH降至正常上限以下。124例（91．18％）获随访，随访时间6～112个月，中位随访时间49个月；12例（8．82％）失访。术后6个月有2例（1．47％）甲状旁腺癌患者肿瘤复发，其余病例无复发。3例（2．21％）甲状旁腺癌患者分别于术后18，19及23个月死亡，其中2例死于甲状旁腺癌全身转移，1例死于心血管意外。结论原发性甲状旁腺功能亢进的临床表现多样，手术是治疗原发性甲状旁腺功能亢进的有效手段。

Experience of Diagnosis and Treatment of 136 Patients with Primary Hyperparathyroidism

Objective To analysis the clinical symptoms, diagnosis, and treatment of primary hyperparathyroi- dism （PHPT）. Methods A retrospective study was made in consecutive patients with PHPT who performed operation and had integral data between January 2004 to December 2012 in West China Hospital. Results The 136 cases were composed of 52 cases （38.23%） bone types, 17 cases （12. 50%） nephrocalcinosis, 7 cases （5. 15%） skeletal and renal involvements, 24 cases （17. 65%） asymptomatic primary hyperparathyroidism, and 36 cases （26. 47%） combined with other clinical symptoms. The preoperative parathyroid hormone （PTH） levels were （106. 20_＋ 88.88） pmol/L （6. 91-390 pmol/L） and serum calcium were （3.12＋0. 66） mmol/L （2. 15-5.77 mmol/L）. The coincidence rate between the examinations preoperation and pathology： B type ultrasound was 75.00%, 99Tcm-MIBI scan was 85.29 %, ultrasound and 99Tcm-MIBI combined with computerized tomography （CT） scan was 86. 76%. Pathology presentation. 129 patients （94. 85%） were benign lesions, 7 cases （5. 15%） were parathyroid carcinoma. Of the 129 patients, 114 cases （95.80%） were single parath- yroid adenoma, 5 cases （4. 20%） were multiple parathyroid adenoma or combined parathyroid hyperplasia, 10 cases （7. 75%） were parathyroid hyperplasia. Of the patients, the PTH level decreased to below normal upper limit within 3 days after surgery in 124 cases （91.18%）. One hundred and twenty-four cases （91.18%） were followed-up. The follow-up time was 6-112 months, a median follow-up time was 49 months. Twelve patients （8.82%） were lost to follow-up, 2 patients （1.47%） with carcinoma recurrence, the rest patients without recurrence and metastasis. Three patients （2.20%） with parathyroid carcinoma died. Of the 3 patients, 2 died of systemic metastasis of parathyroid carcinoma in 18 and 23 months after surgery, 1 died of cardiovascular accident in 19 months after surgery. Conclusion Surgical excision of the lesion parathyroid tissue is the most effective treatment for PHPT.