原发性甲状旁腺功能亢进症的诊断与手术治疗

目的总结原发性甲状旁腺功能亢进症的外科诊断与治疗经验。方法回顾性分析2000～2005年在该科行外科手术治疗的60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60例患者中,联合B超、CT、核素扫描手术前定位诊断率达到90%以上。手术后患者临床症状缓解,骨质疏松改善,骨折愈合,有39例患者出现短期低血钙,35例出现面部、手足麻木,12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49例患者甲状旁腺激素均在2个月内恢复到正常,2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、减少骨关节和泌尿系损害的目的。

Diagnosis and surgical treatment of patients with primary hyperparathyroidism

[Objective] To evaluate the feasibility and efficacy of surgical treatment for patients with primary hyperparathyroidism. [Methods] The studies were analyzed in 60 patients with PHPT who underwent parathyroidectomy from 2000 to 2005. [Results] Eight patients were asymptomatic. The skeletal manifestations were found in 25 cases, urinary stones in 12 cases, and both skeletal manifestations and urinary stones in 15 cases. Pathological bone fractures occurred in 18 cases. Hypercalcemia was discovered in all patients, which ranged from 2.7 to 3.8 mmol/L. Preoperatively all patients underwent sonography, CTand /or scintigraphy. To overall preoperative image-directed localization rate was more than 90%. Follow up was done from 6 to 24 months after surgery. The symptoms and signs of all patiens relieved postoperatively with the improvement of osteoporosis and healing of bone fracture. Out of 39 presented with temporatory hypocalcemia, 35 showed circumoral paresthesia in whom 12 showed tetany, 15 showed eucallcemia and one had mild hypercalcemia after operation. The serum calcium was normal in all cases with hypocalcemia for 1~3 weeks. PTH level decreased to normal from 2 weeks to 2 months in 49 cases and was still mildly higher than normal in 2 cases. [Conclusions] Parathyroidectomy is an effective approach for patients with pHPT. With preoperative image-directed localization techniques, minimally invasive parathyroidectomy is a valid surgical strategy.