原发性甲状旁腺机能亢进症的诊断与治疗

目的探讨原发性甲状旁腺机能亢进征（ＰＨＰＴ）的诊断和治疗有效方法。方法对３７例ＰＨＰＴ患者的临床表现，手术治疗方法，术前后血和尿钙、磷浓度、末稍血甲状旁腺激素（ｉＰＴＨ）及骨的Ｘ线表现进行了回顾性分析总结。结果ＰＨＰＴ患者的主要临床表现是持重部位骨关节对称性疼痛；实验室检查，血钙、尿钙、尿磷及血碱性磷酸酶、ｉＰＴＨ升高，血磷降低；Ｘ线表现为骨质疏松；手术时用大马蹄形切口，利用甲状腺胸腺韧带及术中甲状腺下动脉注射亚甲蓝染色等方法，可帮助显露寻找甲状旁腺。结论综合分析仍然是ＰＨＰＴ的基本诊断方法，手术的关键是寻找甲状旁腺肿瘤，对于ＰＨＰＴ诊断明确而病变部位不明确者，可采用低位大马蹄形切口。

Diagnosis and treatment of primary hyperparathyroidism

Objective To study the diagnosis and treatment of hyperparathroidism. Method 37 patients with primary hyperparathroidism (PHPT) were confirmed pathologically. The course of the disease varied,the longest one being 14 years and the shortest one 3 months. Result 35 patients had parathyroidoma,1 hyperplasia of parathyroid, and 1 carcinoma of parathyroid. The main clinical manifestation was symmetrical pain of the supporting bones and joints,hypercalcemia,hypercalcinuria,hypophosphatemia hyperalkaline phosphatasemia,and increase of iPTH in peripheral blood.X ray examination showed ostroporosis and decalcification,accompanied with multiple fracture occasionly, we injected 99m Tc and MiBi into inferior thyroid artery as a demonstration for the diagnosis of tumor of parathyroid. Conclusion The key procedure of the operation was to search for tumor of parathyroid.We used thymo thyroid ligament as guide and injected methylene blue into the artery duing operation to search thyroid.