167例原发性甲状旁腺功能亢进症患者的临床分析

目的 分析原发性甲状旁腺功能亢进症（primary hyperparathyroidism，PHPT）患者的临床特点，减少患者的诊治歧路及合并症。方法 回顾性分析北京积水潭医院普外科自2010年1月至2018年3月诊治的原发性甲状旁腺功能亢进患者，统计其一般资料、临床表现及处理情况、术前影像定位检查等，对再次手术资料及术中标本、术后病理、甲状旁腺激素（parathyroid hormone，PTH）等进行分析。结果 原发性甲状旁腺功能亢进症病例数逐年增加，可来源于临床多科室，根据其临床表现分型，以骨型及骨肾型为多见，各占53.2%和24.6%，其中有骨折病史者30例，占18%，曾行骨科手术者24例，占14.4%，其中行2次及以上骨科手术者5例，占骨科手术患者的21%。有骨科事件（骨折或可疑骨肿瘤者）患者PTH值与其他患者比较，差异有统计学意义（P=0.003）。11例患者非初次手术，其中5例为既往异位甲状旁腺手术，占再手术的45.5%。甲状旁腺增生组与甲状旁腺癌组及腺瘤组术前PTH值差异有统计学意义（P<0.05），3组间病灶湿质量差异无统计学意义（P>0.05）。结论 对于PHPT患者应注重其临床早诊断，加强对有骨折、骨畸形变、骨质疏松等患者的筛查，术前良恶性较难确定，PTH有提示意义，应结合术前影像及术中快速PTH检测技术，做到定位准确，提高手术成功率，避免因异位多次手术，或术中反复探查等。对于复发患者，应考虑到异位病灶或甲状旁腺癌转移等。

Clinical analysis of 167 patients with primary hyperparathyroidism

Objective To analyze the clinical features of primary hyperparathyroidism (PHPT) patients, reduce the diagnosis and treatment of the crossroads and complications. Methods Retrospective analysis of the patients with primary hyperparathyroidism diagnosed from January 2010 to March 2018 in Department of General Surgery of Beijing Jishuitan Hospital, general information, clinical manifestations and treatment, preoperative image location examination, reoperation data analysis and intraoperative specimen, postoperative pathology, parathyroid hormone (PTH) analysis, etc. Results The number of cases of primary hyperparathyroidism has increased year by year, and can be derived from clinical multi-disciplinary departments.According to their clinical manifestations, bone type and bone kidney type are common, each accounted for 53.2% and 24.6%, of which have a history of fracture 30 cases, accounting for 18%, Orthopedic surgery was performed in 24 cases, accounting for 14.4%, of which 2 or above orthopaedic surgery in 5 cases, accounting for 21% of orthopedic surgery patients. Patients with orthopedic events (fractures or suspected bone tumors) had significantly different PTH values than other patients (P=0.003).Eleven patients were not first operation, accounting for 6.6%, of which 5 were former ectopic parathyroid surgery, which accounted for 45.5% of reoperation. There was a significant difference in preoperative PTH among the parathyroid gland hyperplasia group,the parathyroid carcinoma group and the adenoma group (P<0.05). There was no significant difference in the wet weight between the three groups.Conclusion The clinical early diagnosis should be paid attention to PHPT patients, screening of patients with fracture, bone deformity or osteoporosis should be strengthened.It is difficult to determine the preoperative benign or malignant and PTH was significant. We should combine preoperative imaging and intraoperative rapid PTH detection technique to achieve accurate positioning, improve the success rate of operation, avoid multiple surgeries, or repeatedly explore during operation. For patients with recurrent disease, ectopic lesions or parathyroid carcinoma metastasis should be considered.