棕色瘤的鉴别诊断与外科治疗

目的:探讨棕色瘤的诊断与鉴别诊断,评估手术治疗效果。方法:回顾性分析我院1990年1月至2012年1月确诊棕色瘤9例,其中男性5例,女性4例,平均年龄37.6岁(19~51岁),平均病程5.4年(2.5年~15年)。所有患者均伴有不同程度消瘦乏力、厌食恶心、全身多处疼痛及骨密度降低、甲状旁腺激素增高。全部病例均为多发。所有患者术前均行颈部薄层CT扫描以确定甲状旁腺位置及有无肿块。承重骨上的棕色瘤行手术切除、同种异体骨植骨,必要时加用内固定;非承重骨上的棕色瘤无需特别处理。结果:随访时间2年~5.5年,平均随访时间3.2年。术后6周左右未切除的棕色瘤病损表现出好转迹象,皮质骨吸收处变化最早最明显,术后3~6月骨质疏松明显好转。异体骨平均愈合时间为13.2月。无一例发生感染,异体骨排斥反应及内固定断裂。随访期未见棕色瘤进一步形成。结论:有尿路结石、高血钙、广泛骨质疏松的少见部位骨巨细胞瘤样患者应高度怀疑棕色瘤。病理诊断应与骨巨细胞瘤仔细鉴别。棕色瘤经外科手术及抗骨质疏松等综合治疗可以取得良好疗效。

The differential diagnosis and surgical treatment of brown tumor

Objective:To investigate surgical therapy and differential diagnosis of brown tumor,surgical treatment evaluation. Methods:In our hospital 9 cases of diagnosed brown tumor who underwent from January 1990 to January 2012 were analyzed retrospec-tively,including 5 males and 4 females. Mean age was 37. 6 years(19 ~51years),and the average duration was 5. 4 years(2. 5 ~15years). All patients with different degrees of fatigue,anorexia,disgusting,the whole body pain,decreased bone density and parathyroid hormone increased. were multiple. All patients underwent preoperative neck thin slice CT scan to determine the position and whether mass. The brown tumor on weight-bearing bone underwent the surgical removal and allograft,if necessary,combinend with internal fixa-tion;the brown tumor of non-weight bearing bones without special treatment. Results:The follow-up time was 2 years-5. 5years,the av-erage follow-up period was 3. 2 years. About 6 weeks after the operation the lesion of without resection brown tumor appeared signs of re-pair. Cortical bone absorption was at the earliest and the most obvious change. 3~6 months after the operation osteoporosis significantly improved. The average healing time of allogeneic bone was appro-ximately 13. 2 months. There was no case of infection,bone allograft rejection and breakage of the internal fixation. Brown tumor didn’t further form in follow-up period. Conclusion:Patients with urinary tract stones,hypercalcemia and giant cell tumor of bone in rare part of widely osteoporosis should be highly suspected of brown tumor. Pathological diagnosis should be carefully identified with giant cell tumor of bone. Brown tumor by surgery and anti osteoporosis treat-ment can achieve good therapeutic effect.