48例甲状旁腺腺瘤和腺癌的临床分析

目的探讨甲状旁腺腺瘤(PTA)和腺癌(PTC)的诊断和外科治疗。方法回顾性分析48例PTA和PTC的临床资料。48例患者中,腺瘤46例,腺癌2例,平均病程为(3．65±2.83)年;血钙和血清甲状旁腺素(PTH)均高于正常;在多普勒彩超和99mTc-甲氧基异丁基异腈(MIBI)定位明确且吻合的31例单侧单发病例中,18例行单侧甲状旁腺探查,无肿瘤遗漏;13例仍行双侧探查,但对侧探查均阴性。全部病例均行肿瘤切除,2例腺癌另行同侧甲状腺腺叶切除及改良颈淋巴结清扫。结果全部患者的临床症状在术后均得到缓解,随访1个月至10年,无复发病例。术后血钙较术前有显著降低,在术后3 d时,血钙及PTH平均水平甚至低于正常,呈一过性低钙表现;在术后1周至3个月,血钙及PTH水平逐渐恢复正常。多普勒彩超的敏感性和阳性预测值分别为97．0％和94.1％, 99mTc-MIBI分别为100％和97．3％。结论慢性骨病、反复发作的泌尿系结石、溃疡病及胰腺炎患者,应作为PTA及PTC的疑诊对象;血钙检查作为筛查手段应列为常规;血钙和血清PTH测定是可靠的定性诊断手段;多普勒彩超和99mTc-MIBI相结合可获得准确的定位诊断;定位明确的腺瘤结合术中冰冻病理检查行单侧甲状旁腺探查是可行的。

Diagnosis and surgical treatment of 48 cases of parathyroid adenoma and parathyroid carcinoma

OBJECTIVE: To summarize the experience in diagnosis and surgical treatment of parathyroid adenoma and carcinoma (PTA and PTC) in our department. METHODS: The clinical and pathological data of 48 cases admitted in our department from Jan 1995 to Dec 2005 were reviewed. Among the 48 cases, 46 cases were of parathyroid adenoma and 2 cases of parathyroid carcinoma. The average clinical history of the 48 cases was 3.65 +/- 2.83 years. The serum calcium and PTH levels were elevated in all the 48 cases. In 31 cases ultrasonographic results were consisted with that of 99mTc-MIBI scintigraphy. Unilateral neck exploration was performed in 18 cases and no case with post-operative tumor remnants was found. In other 13 cases bilateral exploration was performed but no one case was found to be tumor positive in the opposite side of the glands. Tumors resection was performed in all the 48 cases, among which in the 2 cases with PTC, ipsilateral thyroid lobe excision and modified neck dissection were also performed. RESULTS: Clinical symptoms of all the patients were relieved after operation. No recurrent case was found during the follow-up periods (from 1 month to 10 years). The average level of serum calcium and PTH declined significantly after operation. The post-operational serum calcium and PTH levels at 3 days after operation were even lower than normal. Transient post-operational hypocalcemia was found in almost all the patients. The serum calcium and PTH levels in all patients recovered to normal level within a periods from 1 week to 3 months after operation. The sensitivity and positive prediction value of localization methods were 97.0% and 94.1% of ultrasonography, respectively, and 100% and 97.3% of 99mTc-MIBI scintigraphy, respectively. CONCLUSION: Patients with chronic bone diseases, repeatedly recurrent nephrolithiasis, peptic ulcer disease or pancreatitis should be regarded as suspicious cases of PTA and PTC, and serum calcium assay should be performed as a routine screening procedure. Serum calcium and PTH assays are both reliable methods for the diagnosis of PTA and PTC. A combination of ultrasonography and 99mTc-MIBI scintigraphy is sufficient for locating adenomas. Accompanied by intraoperative pathological examination, unilateral neck exploration is an acceptable approach for patients with definitely preoperative confirmed adenoma localization.