CAJ | 학술논문

目的探讨甲状旁腺癌的诊断和治疗.方法回顾分析1967年1月至2009年12月收治的9例甲状旁腺癌的诊治经验并总结国内文献报道的部分甲状旁腺癌的相关病例资料.结果本组9例中8例为本院病例,占本院原发性甲状旁腺功能亢进患者的8.9%(8/90),1例为外院手术后转入.8例伴重度甲状旁腺功能亢进,1例无功能;据术前资料、术中探查和冰冻病理检查诊断为甲状旁腺癌共8例;院外1例误诊.初次手术采用颈部小切口下直接手术:2例甲状旁腺肿瘤切除;5例行肿瘤扩大切除术,其中3例加中央区淋巴结清扫术;1例行甲状旁腺癌姑息性切除术;外院1例仅行甲状腺次全切除术,后追加中央区淋巴结清扫术.均经术后病理确诊为甲状旁腺癌,无颈淋巴结转移.随访1～14年,8例无癌复发,1例姑息手术者术后2年死亡.国内相关文献中报道甲状旁腺癌加本组共146例,在原发性甲状旁腺功能亢进中发生率为1.8%～11.5%.结论根据重度高钙血症的临床表现、B超、Tc99m-sestemibi检查、术中探查见肿瘤与周围粘连和病理检查结果可诊断为甲状旁腺癌;初次手术方法宜采用包括同侧相邻组织和甲状腺在内的肿瘤扩大切除术,可用微创小切口手术施行,预后良好.
목적 탐토갑상방선암적진단화치료.방법 회고분석1967년1월지2009년12월수치적9례갑상방선암적진치경험병총결국내문헌보도적부분갑상방선암적상관병례자료.결과 본조9례중8례위본원병례,점본원원발성갑상방선공능항진환자적8.9%(8/90),1례위외원수술후전입.8례반중도갑상방선공능항진,1례무공능;거술전자료、술중탐사화빙동병리검사진단위갑상방선암공8례;원외1례오진.초차수술채용경부소절구하직접수술:2례갑상방선종류절제;5례행종류확대절제술,기중3례가중앙구림파결청소술;1례행갑상방선암고식성절제술;외원1례부행갑상선차전절제술,후추가중앙구림파결청소술.균경술후병리학진위갑상방선암,무경림파결전이.수방1～14년,8례무암복발,1례고식수술자술후2년사망.국내상관문헌중보도갑상방선암가본조공146례,재원발성갑상방선공능항진중발생솔위1.8%～11.5%.결론 근거중도고개혈증적림상표현、B초、Tc99m-sestemibi검사、술중탐사견종류여주위점련화병리검사결과가진단위갑상방선암;초차수술방법의채용포괄동측상린조직화갑상선재내적종류확대절제술,가용미창소절구수술시행,예후량호.
Objective To investigate the diagnosis and surgical treatment of parathyroid carcinoma. Methods The clinical data of 9 cases of parathyroid carcinoma treated from January 1967 to December 2009 was analyzed retrospectively with the review of related Chinese literatures. Results Parathyroid carcinoma accounted for 8.9% (8/90)of all patients with primary hyperparathyroidism in our hospital, and the other one case was transferred from another hospital. Of the patients, 8 cases were found with primary hyperparathyroidism. Primary surgery was carried out with small incision: 5 patients underwent en bloc resection, among which, 3 cases received central lymph node dissection; 2 patients received simple parathyroidectomy; one case underwent palliative tumor resection. The case from another hospital received subtotal thyroidectomy. Considering preoperative, intraoperative data and frozen sections pathology, all patients were diagnosed as parathyroid carcinoma. Nine patients were followed-up for 1-14 years, no recurrence occurred, and the patient received palliative resection died from carcinoma two years after the operation. In previous Chinese literatures and this group, there were total 146 patients reported as parathyroid carcinoma. Those patients were diagnosed through routine histopathology, accounted for 1.8%-11.5% of patients with primary hyperparathyroidism. Conclusions The diagnosis of parathyroid carcinoma is established according to severe hypercalcemia, clinical features, subset B-ultrasound and Tc99m-sestamibi scanning, intraoperative finding of adherence to close structures and histopathology. The initial surgical procedure of choice is en bloc resection of the tumor by minimally invasive small incision, including adjacent structures and ipsilateral thyroidectomy. The prognosis is favorable after the operation.