摘要
目的总结甲状旁腺癌（PTC）的诊治经验。方法回顾分析6例PTC的临床资料。结果5例有原发性甲状旁腺功能亢进症的表现，3例可扪及颈部肿块，4例高钙血症[（3．62±0．56）mmol／L]，4例血甲状旁腺素（PTH）升高达正常上限的2倍以上。3例术中快速病检确诊，2例术后石蜡病检及免疫组化确诊，1例术后石蜡病检及免疫组化结合临床资料确诊。5例行甲状旁腺切除术＋患侧甲状腺次全切除术，随访1～5年，其中1例术后复发；1例仅行甲状旁腺肿瘤切除术的甲状旁腺癌伴多发性骨转称患者，术后16d死于多器官功能衰竭。结论PTC术前诊断困难，术前血生化检查，PTH，99mTc-MIBI，超声、CT检查及术中大体标本观察和快速病检有利于明确诊断。手术方式以选择甲状旁腺切除术＋患侧甲状腺次全切除术为宜。
Objective To summarize the experience for diagnosis and treatment of parathyroid carcinoma （ PTC ）. Methods The clinical data of 6 patients with PTC were retrospectively analyzed. Results Five patients complained of primary hyperparathyroidism, 3 patients had manifestations of palpable neck mass, 4 patients were admitted for hyperealcemia with calcium level of （ 3.62 ± 0.56 ） mmol/L, and in 4 patients the parathyroid hormone （PTH） level was higher than two fold of the normal upper limit. Frozen section histopathology established diagnosis in 3 patients, routine histopathology combined with immunohistochemistry established the diagnosis in 2 patients, and routine histopathology combined with immunohistochemistry and clinical data established the diagnosis in 1 patient. Parathyroidectomy and ipsilateral subtotal thyroidectomy was performed in 5 patients, who were followed up for 1 -5 years, recurrence in 1 patient 3 years after operation ; tumor resection alone was performed in 1 patient with parathyroid cancer complicated with multiple bone metastasis, and the patient died of MOF 16 clays postoperation. Conclusions The diagnosis of PTC is difficult before operation. Routine blood examinations, blood PTH , 99 mTc- MIBI scintigraphy, ultrasonography, CT, observation of specimen, and frozen section histopathology during operation are helpful to diagnosis. The surgical procedure of choice is parathyroidectomy and ipsilateral subtotal thyroidectomy.
出处
《中国普通外科杂志》
CAS
CSCD
2008年第5期419-422,共4页
China Journal of General Surgery
