45例甲状旁腺肿瘤临床分析

目的:探讨甲状旁腺肿瘤的诊断、术前定位、外科治疗及预后.方法:对2001年-2012年间收治的45例甲状旁腺肿瘤病例的临床资料进行回顾性分析.结果:全组45例甲状旁腺肿瘤术前均通过B超和或CT、99mTc-MIBI检查得以定位,阳性率分别为86.7％,93.8％,100％.45例均行手术治疗,均为单发肿瘤,其中左上7例,左下23例,右上4例,右下11例.术后病理证实39例为腺瘤,1例腺癌和5例囊肿.囊肿均为非功能性,腺瘤、腺癌均伴原发性甲状旁腺功能亢进(PHPT).术前PHPT患者均有不同程度的血钙升高和血磷降低,其中24例甲状旁腺激素(PTH)升高；术后血钙明显下降,血磷明显上升(均P＜0.05),1周至3个月恢复正常,PTH明显降低(P＜0.05),22例术后1～5 d即正常,2例1年后正常.术中PTH(IOTPH)判断腺瘤成功切除率100％.40例获随访3个月至10年,均无复发和病灶遗漏.结论:甲状旁腺肿瘤起病缓慢,临床表现复杂多样.血钙、血磷以及血PTH的检测有助于PHPT的诊断；B超可作为甲状旁腺肿瘤的术前定位的首选检查,联合CT和99mTc-MIBI核素扫描能提高定位率；手术治疗为甲状旁腺肿瘤的首选治疗方法,效果良好.

Clinical analysis of parathyroid tumors: a report of 45 cases

Objective: To investigate the diagnosis, preoperative localization, surgical treatment and prognosis of parathyroid tumors.Methods: The clinical data of 45 patients with parathyroid tumors admitted between 2001 to 2012 were retrospectively analyzed.Results: All the parathyroid tumors of the patients were correctly located by B-type ultrasound, and/or CT scan and 99mTc-MIBI, with a sensitivity of 86.7%, 93.8% and 100%, respectively. The 45 patients underwent surgical treatment, and all their lesions were solitary, among which there were 7 left superior, 23 left inferior, 4 right superior, and 11 right inferior parathyroid glands. The postoperative pathology identified that the lesions were parathyroid adenoma (39 cases), adenocarcinoma (1 case) and cyst (5 cases), respectively. The cysts were non-functional, while the adenomas and adenocarcinoma were all associated with primary hyperparathyroidism (PHPT). Before surgery, there were varying degrees of serum calcium level increase and serum phosphate level decrease in all of the PHPT patients, 24 cases of whom had a high parathyroid hormone (PTH) level. The serum calcium levels were decreased and serum phosphate levels were increased significantly in these patients after surgery (both P<0.05), and both levels returned to normal within 1 week to 3 months. The high PTH levels were also significantly decreased after surgery (P<0.05), which became normal within 1 to 5 d in 22 cases, and after 1 year in 2 cases. The intraoperative PTH (IOPTH) monitoring indicated that the successful resection rate for adenoma was 100%. Follow-up was obtained in 40 patients for 3 months to 10 years, during which no recurrence or missed lesion was noted.Conclusion: Parathyroid tumors have a slow onset with diverse clinical manifestations. Serum calcium, phosphorus and PTH levels detection are helpful to diagnose PHPT. Ultrasonic examination can be used as the first option for preoperative localization of parathyroid tumors and the localization rate can be enhanced by combination of CT and 99mTc-MIBI. Surgical resection is effective and the first choice for treatment of parathyroid tumors.