原发性甲状旁腺功能亢进症73例诊断分析

目的:探讨原发性甲状旁腺功能亢进症(PHPT)的临床表现及诊断方法.方法:回顾分析我院2000-2009年间收治的73例PHPT患者的临床资料.结果:PHPT临床表现多样,误诊率高.73例中首发症状主要以骨骼病变(骨关节痛24例,骨折8例),肾结石(14例)和消化道症状(12例)等为主,亦有无症状者.73例(100%)血清钙至少一次升高,69例行甲状旁腺素(PTH)检查均增高.行超声、99mTc-MIBI、CT和MRI等定位诊断,四者结合术前定位准确率100%.73例均行手术治疗,病理证实甲状旁腺腺瘤72例,甲状旁腺增生1例.术后患者症状改善,血清钙、PTH值明显下降.结论:应提高对PHPT的认识,重视血钙检查,对疑诊患者早期检测PTH、颈部B超等,确诊者尽早手术,可使患者保留劳动能力,提高生存质量.     

超声在原发性甲状旁腺功能亢进诊治中的应用进展

原发性甲状旁腺功能亢进(PHPT)在甲状旁腺疾病中最为常见,随着影像学技术的不断进步,其诊治水平不断提高,超声因其独特的优势已成为诊断PHPT的首选影像学方法。本文就超声在PHPT诊治中的应用进展进行综述。     

原发性甲状旁腺功能亢进的超声评价

１９８３～１９９２年，６１例原发性甲状旁腺功能亢进（男性１２例，女性４９例，年龄１３～７０岁）经手术病理证实，其中５５例经超声检查。超声频率为３．５或７．５ＭＨｚ。结果：正常位置甲旁亢病变（包括腺癌及增生）显示率为９５％（４３／４５）；病理测值较超声测值为大（Ｐ＜０．０１）；超声探测敏感性５３．３％，特异性９６．２％，正确率８１．８％，阳性预测值８１．５％，阴性预测值８６．５％。还探讨了提高本病超声诊断水平问题：①熟悉解剖，防止假阳性及假阴性，②鉴别原发与继发甲旁亢，③掌握多发性内分泌腺瘤的特点，④提高超声分辨及灵敏度，⑤反复、认真的检查是早期及正确诊断的关键。     

原发性甲状旁腺功能亢进超声定位诊断：漏、误诊分析

目的 分析超声定位原发性甲状旁腺功能亢进症(PHPT)漏、误诊原因。方法 回顾性分析92例术前超声定位漏、误诊PHPT患者共96个病灶,观察病灶超声表现。结果 超声漏诊64个病灶的中位最大径为1.3 cm,32个位于甲状腺背侧、16个位于甲状腺上极上方或下极下方、16个异位;48个甲状腺背侧、上极上方及下极下方病灶中, 26个(26/48,54.17%)病灶厚度≤0.5 cm。超声误诊27个病灶为甲状腺结节,其中位最大径为1.8 cm,其中17个紧邻甲状腺被膜,7个部分、3个完全位于甲状腺内;6个呈均匀低回声,19个为混合回声,2个为中高回声。超声误诊5个病灶为淋巴结,其中位最大径为1.1 cm, 2个呈均匀低回声、3个呈混合回声(2个周边低回声、内部中高回声,1个周边中高回声、内部低回声)。结论 超声定位PHPT漏、误诊与病灶体积小、呈薄片状或异位等因素有关;应注意鉴别甲状旁腺病变、甲状腺结节与淋巴结。     

超声对甲状旁腺功能亢进症的诊断价值

目的　评价超声对甲状旁腺功能亢进症的诊断率及应用价值。方法　甲状旁腺功能亢进症患者 2 10例 ,比较分析其术前超声检查与手术所见和病理学诊断结果 ,并与核素和CT对比观察。结果超声对甲状旁腺功能亢进症诊断总的敏感性 68.62 % ,特异性 93 .79%。对甲状腺上极背侧病变的敏感性低于下极 (P <0 .0 5 ) ,对异位病变的敏感性低于正常部位 (P <0 .0 5 )。单从声像图上难以区分甲状旁腺腺瘤、增生或癌 ,需结合临床考虑。结论　超声是甲状旁腺功能亢进症术前定位的有效手段     

超声引导下微波消融治疗原发性甲状旁腺功能亢进症1例并文献复习

原发性甲状旁腺功能亢进症(甲旁亢)是内分泌系统的常见疾病之一,传统治疗方案包括手术治疗和药物治疗.外科手术虽然是首选的治疗手段,但部分患者可能存在手术禁忌证或者由于各种因素拒绝手术,药物治疗亦无法从根本上去除病因故疗效欠佳,因此探索微创手段治疗原发性甲旁亢具有重要的临床意义.微波消融技术曾用于良恶性甲状腺结节、继发性甲...     

原发性甲状旁腺功能亢进症患者心脏超声特点及相关因素分析

目的 分析原发性甲状旁腺功能亢进症(PHPT)患者心脏结构及功能特点,并探讨相关影响因素。     

高频超声筛查甲状旁腺探讨反复发作泌尿系结石与原发性甲状旁腺功能亢进的关系

目的 应用高频超声筛查甲状旁腺探讨泌尿系结石与原发性甲状旁腺功能亢进(PHPT)的关系。方法 对200例泌尿系结石患者(结石组)及200例健康体检者(对照组)行甲状旁腺超声扫查,观察甲状旁腺显示情况及病变;并对超声发现异常者行血清甲状旁腺激素(PTH)、血钙、血磷检查。结果 结石组中,高频超声显示甲状旁腺136例(136/200,68.00%),发现甲状旁腺肿块28例(28/200,14.00%),肿块体积(588.93±15.25)mm³。对照组中,高频超声显示甲状旁腺90例(90/200,45.00%),发现甲状旁腺肿块4例(4/200,2.00%),肿块体积(84.74±12.51)mm³。两组间高频超声甲状旁腺显示率、甲状旁腺肿块显示率及肿块体积差异均有统计学意义(P均<0.05)。结石组12例甲状旁腺肿块患者为PHPT,另16例及对照组4例甲状旁腺肿块患者血清PTH、血钙、血磷均正常。两组间PHPT发生率差异有统计学意义(P<0.05)。结石组泌尿系结石发作≥3次者PHPT发生率(7/53,13.21%)高于结石发作<3次者(5/147,3.40%;P<0.05)。超声显示12例PHPT均为单发肿块;7例接受甲状旁腺切除术,术后病理均为腺瘤;5例接受内科药物治疗。结论 PHPT是反复发作泌尿系结石的一个重要且易被忽略的原因,高频超声可作为反复发作泌尿系结石患者甲状旁腺的常规筛查手段。     

多模态影像学术前定位诊断原发性及继发于慢性肾病的甲状旁腺功能亢进症

目的 对比⁹⁹Tc^m-MIBI双时相平面显像、SPECT/CT显像与超声术前定位诊断原发性甲状旁腺功能亢进症(PHPT)及继发于慢性肾病的甲状旁腺功能亢进症(SHPT)的价值。方法 纳入113例术前接受⁹⁹Tc^m-MIBI双时相平面显像、SPECT/CT显像和颈部超声检查的甲状旁腺功能亢进症(HPT)患者,包括95例PHPT及18例慢性肾病SHPT;以术后病理为标准,分析各影像学方法术前定位诊断的价值。结果 术后病理共于95例PHPT中诊断108处病灶,其中90处显像阳性、18处阴性;于18例慢性肾病后SHPT中诊断46处病灶,其中44处显像阳性、2处阴性。双时相平面显像、SPECT/CT显像和超声定位诊断PHPT的准确率分别为87.96%(95/108)、92.59%(100/108)和79.63%(86/108),定位诊断慢性肾病后SHPT准确率分别为58.70%(27/46)、86.96%(40/46)和71.74%(33/46),双时相平面显像对前者显著高于后者(P＜0.001)。双时相平面显像、SPECT/CT显像及超声诊断PHPT准确率差异均无统计学意义(P均＞0.05);对于慢性肾病后SHPT,SPECT/CT显像诊断准确性率显著高于双时相平面显像(P=0.004)而与超声差异无统计学意义(P=0.121),双时相平面显像与超声差异亦无统计学意义(P=0.274)。结论 ⁹⁹Tc^m-MIBI双时相平面显像、SPECT/CT显像及超声术前定位诊断HPT准确率较高。双时相平面显像诊断PHPT效能优于慢性肾病后SPHT;推荐对慢性肾病后SHPT优先行SPECT/CT显像。     

核素显像对原发性甲状旁腺功能亢进可视化诊断进展

原发性甲状旁腺功能亢进（PHPT）是一种常见的内分泌疾病,常伴有钙、磷代谢紊乱及多系统病变。手术切除是治疗PHPT的主要手段,随着微创手术的推广应用,术前分子影像学精准定位成为迫切需要。核素显像双时相^99mTc-MIBI SPECT/CT、¹¹C-choline及¹⁸F-Fluorocholine PET/CT一直是PHPT术前定位研究的热点,现就^99mTc-MIBI、¹¹C-choline及¹⁸F-Fluorocholine基本显像原理,三种核素显像方式在异位/复发病变、多腺体病变、PTH升高与核素显像结果不一致及既往颈部手术史的PHPT术前定位临床应用优缺点新进展相关文献进行综述。     

Preoperative localization of parathyroid adenoma with sonography and 99mTc-sestamibi scintigraphy in primary hyperparathyroidism

PURPOSE: To evaluate the sensitivity, specificity, and usefulness of dual-phase 99mTc-Sestamibi scintigraphy (SS) and sonography (US) of the neck, alone and in combination, as noninvasive adenoma localizing procedures in patients with primary hyperparathyroidism prior to parathyroidectomy. METHODS: We retrospectively analyzed the charts of 79 patients with parathyroid (PT) adenomas and confirmed diagnosis of hyperparathyroidism who were evaluated with SS and US prior to successful parathyroidectomy. RESULTS: Ninety-three adenomas were removed during bilateral neck exploration. SS alone showed a sensitivity of 76% and a specificity of 79% compared with 89% and 75%, respectively, for US performed after SS on the same day. Combination of the 2 procedures yielded a sensitivity of 89% and a specificity of 90%, with 22% discordant results. The differences in sensitivity and specificity between the 2 techniques alone or in combination were not statistically significant. CONCLUSIONS: No benefit was gained from using both SS and US for the preoperative localization of PT adenomas in patients with primary hyperparathyroidism. Each technique can be negatively affected by thyroid enlargement and nodularity. US, when performed by a skilled operator, is a reliable tool for PT adenoma localization. If the US findings are inconclusive, SS should be used.     

原发性甲状旁腺功能亢进症的影像学诊断

目的:探讨超声、CT、99mTc-MIBI和MRI对原发性甲状旁腺功能亢进症(PHPT)的诊断价值。方法:对手术病理证实的142例PHPT患者的影像学资料进行回顾性分析。其中行CT检查113例,B超检查126例,99mTc-MIBI检查81例,MRI检查8例。结果:142例PHPT患者中,手术确诊为单发甲状旁腺腺瘤123例,占86.6%;异位甲状旁腺病变7例;多发性内分泌腺瘤病(MEN)伴甲状旁腺功能亢进症6例;甲状旁腺腺癌8例。CT检查98例诊断为甲状旁腺腺瘤或占位(98/113),B超检查100例诊断为甲旁腺腺瘤(100/126),99mTc-MIBI检查76例诊断为甲状腺腺瘤或病变。结论:PHPT的定性诊断主要靠临床及生化检查,定位诊断靠B超、CT及99mTc-MIBI等影像学检查。如B超、CT和99mTc-MIBI检查相结合,可有助于提高本病诊断的准确度。我们应提高对异位甲状旁腺病变、MEN伴HPT和甲状旁腺腺癌影像表现的认识,避免误诊、漏诊。     

The improvement of renal concentration capacity after surgery for primary hyperparathyroidism

BACKGROUND: Improvement of renal concentration capacity was long ago shown to occur after surgery for primary hyperparathyroidism (pHPT). Study of concentration capacity is of interest, as it was also shown to be a predictive factor for the risk of death in patients with pHPT, and it affected the risk of death independently of 33 other variables in multivariate analysis. METHODS: There were 98 patients with verified pHPT operated on in the years 1958-81, who had urine osmolality determinations performed both before and after surgery: 63 immediately after, and 35 with mean 3.9 years delay (SD = 1.8). Another seven patients with pHPT had urine osmolality determinations performed preoperatively only. Non-parametric sign tests, regression analysis, and correlation tests were performed. RESULTS: Both patients with severe or moderate, and mild pHPT showed a substantial change of renal concentration capacity, with mean increase of 28.3% (SD = 28.4). The increase generally occurred soon after surgery. In eight out of 98 patients, there was no improvement. A relationship was found between improvement and preoperative peak serum calcium level. In seven out of seven patients followed, untreated for mean 5.3 years (SD = 3.2), there was a mean 15% (SD = 8.0) deterioration of renal concentration capacity. CONCLUSIONS: The findings of this study add cause for surgery in patients with pHPT and give no reason for different treatment of severe, moderate or mild disease.     

19例原发性甲状旁腺功能亢进病人的围术期护理

[目的]总结原发性甲状旁腺功能亢进病人的围术期护理措施。[方法]回顾性分析19例原发性甲状旁腺功能亢进病人行手术治疗的临床资料。[结果]本组病人均顺利手术,术后1d～3d发生口唇、手足麻木18例,伴四肢抽搐6例,呼吸困难、少尿、颈部切口下血肿、声音嘶哑各1例;随访0.5年～6.0年,均未复发。[结论]加强原发性甲状旁腺功能亢进病人的围术期护理是手术成功的保证。