摘要
目的探讨原发性甲状旁腺功能亢进(PHPT)的诊断和治疗方法。方法回顾性分析1 5年间收治的3 5例PHPT患者的临床资料。结果2 6例行超声检查的阳性准确率为8 8.5%(2 3/2 6)。2 2例行放射性计算机X线断层扫描(ECT)检查的阳性准确率为9 5.5%(2 1/2 2)。2 7例甲状旁腺腺瘤均行单侧探查;3例甲状旁腺癌均参照甲状腺癌行根治性切除和颈部淋巴结功能性清扫术;4例甲状旁腺增生中2例单侧探查,2例行双侧探查术;1例甲状旁腺腺瘤恶变行患侧的甲状腺和甲状旁腺全切除。其中1例腺瘤并发甲状旁腺危象者经内科紧急处理后急诊手术切除腺瘤,症状缓解。手术后均发生不同程度的低血钙症,应用钙剂后症状缓解。部分患者骨痛缓解或消失。结论超声和ECT可作为首选的定位诊断方法。定性诊断主要依据血钙和血甲状旁腺素的同步升高,一旦明确即应手术治疗。定位明确的甲状旁腺腺瘤可行单侧探查。定位不明确或异位者可在放射性核素指导下行手术探查。甲状旁腺危象应在内科治疗控制症状后积极手术探查。
Objective To explore the diagnosis and treatment of primary hyperparathyroidism （PHPT）. Methods Clinical data of 35 cases of PHPT were retrospectively analyzed. Results 23 out of 26 cases （88. 5% ） undergoing preoperative uhrasonography with a positive result were verified by intraoperative findings. For ECT, the positive rate was 21 out of 23 cases （ 95. 5% ）. Unilateral neck explorations （ UNE ） was performed in 27 cases of parathyroidoma. Two cases of parathyroid hyperplasia were treated by UNE and the other two cases by bilateral neck exploration （ BNE ） . The procedure for 3 cases of parathyroid carcinoma was the same as that for papillary thyroid carcinoma. Unilateral resection of thyroid and parathyroid was done in a case of parathyroidoma with malignant change. Emergency excision of parathyroidoma, after emergency medical management, was performed in a patient with parathyroid storm, and the symptoms subsided postoperatively. All cases developed hypocalcemia in various degrees after surgery, but the symptoms were relieved with the use of calcium gluconate. Conclusions PHPT could be diagnosed according to co-elevated calcemia and PTH. Uhrasonography and ECT should be considered as the methods of first choice for preoperative localization. UNE of parathyroidoma could be feasible if accurate image localizations are available. Radionuclear guided parathyroid resection could be performed in the patients with ectopic parathyroid disease or lesions without accurate localization. Aggressive surgical exploration after medical control of symptoms is the first choice of treatment when parathyroid storm is diagnosed.
出处
《中国普通外科杂志》
CAS
CSCD
2005年第9期653-655,共3页
China Journal of General Surgery
