CAJ | 학술논문

目的探讨肿瘤性甲状旁腺功能亢进的临床表现及手术疗效.方法回顾性分析22例甲状旁腺肿瘤致甲状旁腺功能亢进患者的临床表现、治疗经过及疗效.22例患者中男9例,女13例.首次接受手术治疗15例,均在正常组织内切除肿瘤,如提示恶性肿瘤,则在解剖喉返神经后将肿瘤同邻近的甲状腺组织及同侧气管食管沟淋巴结一并切除.对7例外院术后复发性甲状旁腺癌患者切除局部肿瘤同时行不同区域淋巴清扫术.对术后缺损器官一期修复.术中行甲状旁腺素(parathyroid hormone,PTH)监测,5例患者行预防性气管切开.结果术后病理示甲状旁腺瘤14例,甲状旁腺癌8例,其中伴淋巴转移4例.22例次手术后PTH于术后2h内恢复正常,高钙血症均于术后48 h内消失,1例肿瘤定位困难而行试验性颈部手术者PTH值无下降.术后发生左颈部淋巴管瘘和食管瘘1例,保守治疗后痊愈,另有胸骨愈合不良1例.预防性气管切开者出院时均拔管.首治患者除1例甲状旁腺瘤患者出院后1周死于低钙血症亡外,其余随诊12 ～ 40个月,PTH和血钙均在正常值范围.6例外院术后多次复发且侵犯上消化呼吸道患者中3例随诊16 ～ 34个月PTH和血钙均在正常范围,2例分别于术后6个月和8个月再次局部复发,另1例复发性甲状旁腺癌患者术后PTH及血钙维持正常44个月后再次升高,术后52个月死于高钙血症.结论甲状旁腺肿瘤宜行局部扩大切除并常规术中监测PTH.
목적 탐토종류성갑상방선공능항진적림상표현급수술료효.방법 회고성분석22례갑상방선종류치갑상방선공능항진환자적림상표현、치료경과급료효.22례환자중남9례,녀13례.수차접수수술치료15례,균재정상조직내절제종류,여제시악성종류,칙재해부후반신경후장종류동린근적갑상선조직급동측기관식관구림파결일병절제.대7예외원술후복발성갑상방선암환자절제국부종류동시행불동구역림파청소술.대술후결손기관일기수복.술중행갑상방선소(parathyroid hormone,PTH)감측,5례환자행예방성기관절개.결과 술후병리시갑상방선류14례,갑상방선암8례,기중반림파전이4례.22례차수술후PTH우술후2h내회복정상,고개혈증균우술후48 h내소실,1례종류정위곤난이행시험성경부수술자PTH치무하강.술후발생좌경부림파관루화식관루1례,보수치료후전유,령유흉골유합불량1례.예방성기관절개자출원시균발관.수치환자제1례갑상방선류환자출원후1주사우저개혈증망외,기여수진12 ～ 40개월,PTH화혈개균재정상치범위.6예외원술후다차복발차침범상소화호흡도환자중3례수진16 ～ 34개월PTH화혈개균재정상범위,2례분별우술후6개월화8개월재차국부복발,령1례복발성갑상방선암환자술후PTH급혈개유지정상44개월후재차승고,술후52개월사우고개혈증.결론 갑상방선종류의행국부확대절제병상규술중감측PTH.
Objective To study the clinical features of hyperparathyroidism due to parathyroid tumors, and evaluate the efficiency of surgical management. Methods Twenty-two patients with hyperparathyroidism resulted from parathyroid tumors were reviewed.The age ranged from 32 to 79 years,9 males and 13 females.Recurrent laryngeal nerve was routinely exposed,and procedures were performed in normal tissue in initial surgery.Additional selective neck dissection of levels Ⅱ,Ⅲ,Ⅳ,and Ⅵ was taken in the cases with recurrent cancer.Local flaps were used to repair the esophageal defects after resecting tumors.The recurrent laryngeal nerves of 4 cases had to be sacrificed because they were embeded in the tumor tissues despite the nerves had normal function before operation. Prophylactic tracheostomy was performed in 5 cases.Results Eight cases were identified pathologically as parathyroid carcinoma,of them four with neck metastasis,and 14 cases as parathyroid adenoma after surgery.Their PTH dropped to normal level within two hours after surgery and hypercalcemia disappeared in two days postoperatively.The PTH and serum calcium were in normal range during the follow-up of 12 to 40 months.Recurrence occurred again in two cases in 6 and 8 months after the removal of the recurrent tumor tissues respectively.Esophageal fistula,chylous fistula and dehiscence of sternotomy developed in three cases separately.The tracheostomy was removed in four cases two weeks after operation and in one case six weeks after operation.One patient with parathyroid adenoma died of hypocalcemia about two weeks after operation and another one with recurrent parathyroid carcinoma also died of hypercalcemia 52 months after revised surgery.Conclusion Extended resection of tumor and introperative PTH assay were strongly suggested for the managements of both benign and malignant parathyroid tumors.