手术治疗原发性甲状旁腺功能亢进症11例分析

摘要：对我院近10年来收治的11例原发性甲状旁腺功能亢进症（PHPT）患者的临床资料进行回顾分析。血钙大于2.62mmol/L，伴血PTH同步升高为定性诊断PHPT的主要依据。11例术前均诊断为PHPT。甲状腺旁腺治疗采用单侧小切口探查术，取得良好效果。PHPT诊断应结合临床表现、实验室检查、X线表现综合分析。B超，CT，核素扫描可作为定位有效方法。对于定位准确的单发腺瘤，单侧小切口探查术创伤性小，是很有前途的治疗方法。     

原发性甲状旁腺功能亢进症20例

我国原发性甲状旁腺功能亢进症（primary hyperparathyroidism,PHPT）发病率较低，而且确诊多为出现严重并发症的晚期病例。故其早期诊断和治疗尚存在一些问题值得探讨。     

原发性甲状旁腺功能亢进症的定位诊断与手术治疗

目的探讨原发性甲状旁腺功能亢进症的定位诊断与治疗方法。方法回顾性分析近15年来手术治疗的52例原发性甲状旁腺功能亢进症患者的临床资料。结果所有病例均在术前行B超和X线检查,99mmTc-MIBI核素扫描36例,所有病例均术中静脉快速滴注亚甲蓝。行甲状旁腺腺瘤切除术45例(小切口腺瘤切除18例),甲状旁腺增生切除术4例,根治性甲状旁腺癌切除术3例。病理性骨折18例,骨、关节痛22例,泌尿系结石病变6例,无症状者6例。X线检查全组患者均表现为骨质疏松。全组血钙升高在2.7-4.3mmol/L之间,平均(3.0±0.5)mmol/L。38例患者术前测定甲状旁腺激素升高在305-1813pg/mL之间,平均(628.3±87.6)pg/mL。B超术前定位诊断率82.6%,99mmTc-MIBI核素扫描的定位诊断率88.9%,术中静滴亚甲蓝染色定位诊断率96.2%。术后36例患者出现短期低血钙,24例出现面部、手足麻木,12例出现手足抽搐,经钙剂治疗血钙恢复正常。患者术后甲状旁腺激素均恢复正常,3例甲状旁腺癌患者术后升高,经再次手术恢复正常。45例获随访,随访时间3个月至15年,临床症状缓解,骨质疏松改善,骨折愈合。结论小创伤甲状旁腺切除是治疗原发性甲状旁腺功能亢进症的有效方法。术中亚甲蓝染色结合术前B超、核素扫描定位诊断原发性甲状旁腺功能亢进症,使甲状旁腺肿瘤切除术准确和微创。     

53例原发性甲状旁腺功能亢进症临床分析

目的探讨原发性甲状旁腺功能亢进症（PHPT）的临床变迁及诊治方法。方法回顾性分析我院27年来收治的53例PHPT的临床资料。结果53例PHPT均经手术、病理证实。发病以20～50岁为多，女性明显多于男性，临床表现多样化，病程迁延，误诊率高。全组均表现为不同程度骨病变，其中泌尿系结石加骨病变11例（20．8％）。51例（96．2％）血清钙升高，48例（90．6％）FTH检查均增高。1991年后术前联合B超，CT扫描及甲状旁腺核素扫描，术前定位诊断准确。手术方式以直接甲状旁腺腺瘤切除术为主，占86．7％，一次手术治愈率97．4％。术后随访10个月～10余年，除15例严重骨畸形改善不明显外，其他症状及体征均不同程度缓解，化验指标恢复正常，无永久性甲旁减或喉返神经损伤等并发症。结论对PHPT早期诊断，早期进行有效的病灶切除治疗，可减少严重骨病变的发生，减少致残率，术前影像定位检查的联合使用，综合判断，能够提高定位诊断的准确性.     

原发性甲状旁腺功能亢进症手术方式的选择

原发性甲状旁腺功能亢进症（PHPT）发病率逐年增加。手术切除是治疗PHPT的主要方法。笔者从颈部探查术和微创外科两方面对目前常用手术方式的起源、方法和优缺点进行了详细的阐述。临床医生应该根据术前定位诊断和术中的实际情况决定手术方式；对于定位确切的单发腺瘤可行单侧颈部探查术(UNE)或直接小切口甲状旁腺切除术(DMIP)；对于异位病变可行放射线引导下微创甲状旁腺切除术(RMIP)；内(腔)镜下微创甲状旁腺切除术(EMIP)仅适用于特定的人群。     

甲状旁腺功能亢进症的诊断和治疗

目的探讨原发性甲状旁腺功能亢进症(PHPT)和继发性甲状旁腺功能亢进症(SHPT)的诊断及治疗方法。方法回顾性分析我院19年间收治的15例PHPT和26例SHPT患者的临床资料,诊断依靠血清学、影像学、99mTc-MIBI及临床表现;按病情不同行手术和非手术治疗。结果 41例患者的血清甲状旁腺激素(PTH)均升高,PHPT的血钙水平升高,SHPT的血钙水平降低。彩超、99mTc-MIBI定位诊断准确率分别为73.17%和85.71%。行手术治疗的15例PHPT和3例SHPT患者术后均无复发;非手术治疗的23例SHPT患者均能缓解病情进展。结论 PTH和血钙是HPT定性诊断的主要依据,定位诊断首选彩超、99mTc-MIBI。PHPT以外科手术治疗为主;SHPT以非手术治疗为主,非手术治疗无效者可行手术治疗。     

原发性甲状旁腺功能亢进症66例分析

目的：探讨原发性甲状旁腺功能亢进症及合并高钙危象的诊断与治疗。方法：66例原发性甲状旁腺功能亢进症患者均经手术治疗,59例甲状旁腺腺瘤、4例甲状旁腺增生仅行肿物切除,3例甲状旁腺癌同时切除同侧甲状腺、峡部及周围软组织。结果：66例患者均治愈,术后无甲状旁腺功能减低或喉返神经损伤等并发症。合并高钙危象患者经快速大量补液、利尿、降钙并结合手术治疗,术后血钙下降至正常水平。结论：血钙和甲状旁腺素可作为初步诊断方法,B超及99mTc-MIBI可做出定位诊断,甲状旁腺肿物切除术是有效治疗手段。     

原发性甲状旁腺功能亢进症临床分析（附138例报告）

目的 总结原发性甲状旁腺功能亢进症的诊治体会。方法 回顾性分析本院普通外科2015年1月至2017年11月经手术治疗的138例原发性甲状旁腺功能亢进症病人的临床资料。结果 138例病人,男30例,女108例,均行手术治疗,其中甲状旁腺危象5例,1例行急诊手术治疗。切除病变甲状旁腺150枚。术后病理检查显示：123枚（82.0%）为甲状旁腺腺瘤,9枚（6.0%）为甲状旁腺增生,4枚（2.7%）为甲状旁腺癌,10枚（6.6%）为甲状旁腺囊肿,4枚（2.7%）为甲状旁腺非典型腺瘤。术后第1天甲状旁腺素（parathyroid hormone, PTH）均降至正常,血钙下降。其中48例术后出现低血钙症状,经补充活性维生素D和葡萄糖酸钙,恢复正常。无喉返神经损伤等并发症发生。结论 血钙和PTH可作为原发性甲状旁腺功能亢进的初步诊断方法。甲状旁腺切除术是有效治疗手段。术前准确定位有助于缩小探查范围。对于甲状旁腺危象,给予水化利尿及双膦酸盐降钙治疗、及时早期行甲状旁腺切除术,可取得良好治疗效果。     

原发性甲状旁腺功能亢进症的外科治疗

目的　总结原发性甲状旁腺功能亢进症的外科治疗经验。方法　回顾性分析 1985～2 0 0 2年在我科行外科手术治疗的 5 5例原发性甲状旁腺功能亢进症患者的临床资料。全组病例均行甲状旁腺切除术。结果　 5 5例患者中无症状者 8例 ,骨、关节病变 2 4例 ,泌尿系结石病变 10例 ,骨和泌尿系结石病变 13例 ,病理性骨折 16例。全组血钙均升高 ,在 2 7～ 3 9mmol/L之间 ,平均 (3 1± 0 4 )mmol/L。 5 0例患者术前测定甲状旁腺激素升高在 10 2～ 2 0 0 0pg/ml之间 ,平均 (489 2±6 9 2 ) pg/ml。联合B超、CT、核素扫描术前定位诊断率达 90 9%。术后全组均随访 6个月～ 2年 ,术后临床表现缓解 ,骨质疏松改善 ,骨折愈合 ,有 39例患者出现短期低血钙 ,37例出现面部、手足麻木 ,10例出现手足抽搐。术后有 15例患者血钙正常 ,1例略高于正常值 ,低血钙者经骨化三醇和钙剂治疗 1～ 3周均可改善 ,血钙恢复正常。术后 4 7例患者甲状旁腺激素均在 2个月内恢复到正常 ,3例略高于正常值。结论　甲状旁腺切除术是治疗原发性甲状旁腺功能亢进症的有效方法。经术前影像学定位后行小范围、小创伤的甲状旁腺切除术是可行的手术方法。及时将原发性甲状旁腺功能亢进症患者转入内分泌外科治疗可达到早期治疗、减少骨关节和泌     

原发性甲状旁腺功能亢进症73例诊治分析

目的 探讨原发性甲状旁腺功能亢进症(PHPT)的诊断及治疗方法.方法 回顾分析我院2000年至2009年间收治的73例PHPT 患者的临床资料.结果 全组血钙均升高,均值(3.05±0.49)mmol/L,最高血钙值均值(3.28±0.62)mmol/L.69例测定甲状旁腺激素(PTH),全部增高(119.46～5000.00pg/ml).联合B超、99mTc-MIBI、CT、MIR定位准确率达91.78%.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,部分患者合并甲状腺疾病.术后患者症状改善,血清钙、PTH恢复正常或明显下降.结论 应提高对PHPT的认识,确诊者应尽早手术.     

Two cases of primary hyperparathyroidism

Two cases of primary hyperparathyroidism with urolithiasis are reported. These cases were preoperatively localized by CT-scan and 201T1-chloride scintiscan. Primary hyperparathyroidism is one of the most significant pathogenesis of urolithiasis and determination of serum Ca level is valuable in screening for primary hyperparathyroidism. CT-scan, ultrasonogram and scintiscan with 201T1-chloride are useful and are non-invasive studies to detect preoperative localization of parathyroid tumors.     

Primary juvenile hyperparathyroidism. Report of 24 cases

AIM OF THE STUDY: Primary hyperparathyroidism usually affects elderly patients. Juvenile primary hyperparathyroidism is rare, and raises diagnostic and prognostic problems. The aim of this retrospective study on 24 patients is to establish clinical, histological, and therapeutic features of juvenile primary hyperparathyroidism. PATIENTS AND METHODS: From 1986 to 2001, 673 patients were treated for primary hyperparathyroidism in our department. Twenty four patients were younger than 30 years old (3.5%). There were 14 women and 10 men. Mean age was 23 year (14-30). Clinical manifestations, pathologics findings and postoperative results were studied. RESULTS: Sixteen patients presented a sporadic form of primary hyperparathyroidism with a single adenoma. Clinical manifestations were renal symptoms in 11 cases and acute hypercalcemia syndrome in 2 cases. Seven patients had a NEM I syndrome: parathyroid lesions were 6 hyperplasia and one adenoma. A 27 years old woman presented a recurrent familial isolated hyperparathyroidism. She was operated on 10 years before and at reoperation parathyroid carcinoma was found. Nineteen patients were cured after a post operative follow up ranging from 3 to 168 months. One patient had an asymptomatic hypercalcemia recurrence. Two patients presented permanent hypoparathyroidism treated with calcitriol and calcium. CONCLUSION: Sporadic forms represent majority of cases of juvenile hyperparathyroidism. Renal manifestations are usual. Nevertheless, multiple endocrine neoplasia type 1 has to be evocated.     

原发性甲状旁腺机能亢进症101例分析

１９６３～１９９７年共收治１０１例原发性甲状旁腺机能亢进症。临床特点为：病人年龄较轻，平均３４岁。骨病发生率高且严重，纤维囊性骨炎占６３３％。肾结石、肾钙化少，占３７６％。约４０％病人血钙不高或持续正常。术前颈部查体扪及肿物者１８例，１７例正确。间接定位体征５例均为阳性。这些病例均病程较长，腺体较大，最重１３ｇ，血钙均＞１２００ｍｇ／Ｌ。本组病理学特点腺瘤占９１例，腺癌６例，增生１例。比较了Ｂ超、ＣＴ、９９ｍＴｃＭＩＢＩ在术前定位诊断中的价值。结果表明，Ｂ超、ＣＴ、９９ｍＴｃＭＩＢＩ的灵敏性分别为４５％、８５％、９１％。特异性为９５％、９７％、１００％。准确性为８２％、９４％、９７％。目前在国内此类病例尚少，尤其是对再次手术者，这些非创伤性术前定位检查是有必要的。本组９８例探查，９６例获成功，手术成功率为９７９％。     

Acute primary hyperparathyroidism: experience of 59 cases

Acute primary hyperparathyroidism is a rare disease with a high mortality rate in some series. Between 1960 and 1986, 1000 patients were treated for primary hyperparathyroidism, among them 59 patients with acute hyperparathyroidism. All these patients were successfully operated on; none of them died before surgery. This study reveals the importance of resuscitation and urgent surgery. It is necessary to rehydrate, to correct electrolyte disorders and to lower serum calcium levels, but it is not necessary to obtain normal serum calcium levels before surgery.     

Surgical treatment of primary hyperparathyroidism. Evaluation of 263 cases

A retrospective study of the case-reports of 263 patients explored surgically for primary hyperparathyroidism demonstrated the cause to be: an adenoma (206 cases), a primary hyperplasia (29 cases), or a cancer (3 cases), exploration was negative in 25 cases. Presenting symptoms were mainly urinary, but 15 p. 100 of patients seen during the last two years had been asymptomatic. Nine patients required emergency surgery and 29 had a primary normocalcemic hyperparathyroidism. The two most useful laboratory examinations, apart from measurement of blood calcium and phosphorus levels, were parathormone assay (elevated levels were present in 80 p. 100 of cases) and quantitative bone biopsy (positive in over 80 p. 100 of patients). The surgical approach was mainly cervical, except for repeat operations when ten sternotomies were performed with successful results in 4 cases. Immediate postoperative mortality was quite high (3 p. 100), particularly in the acute forms or those with multiple adenomas, and in patients over 70. Morbidity (hypocalcemia, recurrent nerve palsy) was increased after repeat surgery. Analysis of long-term results, particularly with respect to urinary symptoms, showed marked differences between lesions of single glands (adenoma) and hyperplasia. The most difficult problem to resolve with this surgery is the importance to attach to excision of the parathyroids when lesions are present in several glands.     

Radioguided surgery for primary hyperparathyroidism. Experience in 75 cases

STUDY AIM: To report feasibility and efficacy of radioguided mini invasive hyperparathyroidism surgery. PATIENTS AND METHOD: From November 1998 to August 2000, 75 patients with primary hyperparathyroidism have been operated on by radioguided surgery within 90 to 180 minutes following i.v. injection of a diagnostic dose of MIBI and after parathyroid scanning with planar and oblique views. Exclusion criteria were thyroid pathology requiring surgery and suspicion of multiple endocrine neoplasia. A 20% step-up between the background noise and tissue uptake was the diagnostic threshold for parathyroid hyperfunctioning tissue. RESULTS: A 20% step-up was observed in only 17% of cases overall; all cured, but two. Various angles of application of the probe can result in significant discrepancies of recorded uptake for the same spot. These results demonstrate a physiological step-up between the ipsilateral unaffected upper and lower quadrants of the neck (range: -17 to -8%), because of the proximity of supraortic vessels (upper neck-upper mediastinal gradient: -44 to -30%). Therefore, significant ratios are meaningful only between either the symmetrical left and right controlateral quadrants respectively, and not between the upper and the lower ipsilateral quadrants. Eleven per cent (8/75) of preoperative scannings were non-contributory, and probe detection was contributory in 3/8 cases only. CONCLUSION: Benefit of the technique is limited in routine, but it can be helpful in redo cases if the offending gland is not located in close surroundings of tissues physiologically taking up the radiopharmaceutical (salivary glands, great vessels and heart).