中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2010年
4期
281-283
,共3页
柏楠%崔爱民%张自琴%赵景明%蔺锡侯
柏楠%崔愛民%張自琴%趙景明%藺錫侯
백남%최애민%장자금%조경명%린석후
原发性甲状旁腺功能亢进症%甲状旁腺肿瘤%诊断%外科手术
原髮性甲狀徬腺功能亢進癥%甲狀徬腺腫瘤%診斷%外科手術
원발성갑상방선공능항진증%갑상방선종류%진단%외과수술
Hyperparathyroidism,primary%Parathyroid neoplasms%Diagnosis%surgical procedures,operative
目的 总结原发性甲状旁腺功能亢进症的诊治经验.方法 回顾性分析1992年11月-2008年12月我院收治的91例原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)的临床资料.结果 91例患者中甲状旁腺腺瘤88例(96.7%),腺癌3例(3.3%).血清钙和甲状旁腺素(PTH)均升高.主要表现为骨痛和泌尿系结石.术前B超、CT和ECT99mTc-MIBI定位准确率分别为83.5%(76/91)、60.9%(14/23)、98.6%(69/70).全部病例均行甲状旁腺腺瘤切除术,1例腺癌另行甲状腺腺叶切除加中央区淋巴结清扫.一次手术成功率97.8%(89/91).90例术后随访8个月至14年,87例腺瘤患者获得临床治愈,3例腺癌患者中2例复发,其中1例死亡.结论 原发性甲状旁腺功能亢进症的诊断并不困难,患有慢性骨病、反复发作泌尿系结石、消化性溃疡的患者应作为此病疑诊对象,血钙检查应作为常规;术前影像学检查首选B超和ECT~(99m)Tc-MIBI;定位准确的甲状旁腺瘤采用腺瘤切除术是可行的.
目的 總結原髮性甲狀徬腺功能亢進癥的診治經驗.方法 迴顧性分析1992年11月-2008年12月我院收治的91例原髮性甲狀徬腺功能亢進癥(primary hyperparathyroidism,PHPT)的臨床資料.結果 91例患者中甲狀徬腺腺瘤88例(96.7%),腺癌3例(3.3%).血清鈣和甲狀徬腺素(PTH)均升高.主要錶現為骨痛和泌尿繫結石.術前B超、CT和ECT99mTc-MIBI定位準確率分彆為83.5%(76/91)、60.9%(14/23)、98.6%(69/70).全部病例均行甲狀徬腺腺瘤切除術,1例腺癌另行甲狀腺腺葉切除加中央區淋巴結清掃.一次手術成功率97.8%(89/91).90例術後隨訪8箇月至14年,87例腺瘤患者穫得臨床治愈,3例腺癌患者中2例複髮,其中1例死亡.結論 原髮性甲狀徬腺功能亢進癥的診斷併不睏難,患有慢性骨病、反複髮作泌尿繫結石、消化性潰瘍的患者應作為此病疑診對象,血鈣檢查應作為常規;術前影像學檢查首選B超和ECT~(99m)Tc-MIBI;定位準確的甲狀徬腺瘤採用腺瘤切除術是可行的.
목적 총결원발성갑상방선공능항진증적진치경험.방법 회고성분석1992년11월-2008년12월아원수치적91례원발성갑상방선공능항진증(primary hyperparathyroidism,PHPT)적림상자료.결과 91례환자중갑상방선선류88례(96.7%),선암3례(3.3%).혈청개화갑상방선소(PTH)균승고.주요표현위골통화비뇨계결석.술전B초、CT화ECT99mTc-MIBI정위준학솔분별위83.5%(76/91)、60.9%(14/23)、98.6%(69/70).전부병례균행갑상방선선류절제술,1례선암령행갑상선선협절제가중앙구림파결청소.일차수술성공솔97.8%(89/91).90례술후수방8개월지14년,87례선류환자획득림상치유,3례선암환자중2례복발,기중1례사망.결론 원발성갑상방선공능항진증적진단병불곤난,환유만성골병、반복발작비뇨계결석、소화성궤양적환자응작위차병의진대상,혈개검사응작위상규;술전영상학검사수선B초화ECT~(99m)Tc-MIBI;정위준학적갑상방선류채용선류절제술시가행적.
Objective To summarize the experience on diagnosis and treatment of primary hyperparathyroidism(PHPT).Methods Clinical data of 91 PHPT patients treated in Beijing Jishuitan Hospital from November 1992 to December 2008 were analyzed retrospectively.Results Among 91 PHPT cases,88 were diagnosed as parathyroid adenoma(96.7%),3 were diagnosed as parathyroid carcinoma (3.3%).Serum calcium and PTH levels increased in all cases.Main clinical manifestations were osteodynia and kidney stones.The accuracy rate of preoperative B-ultrasound.CT and ECT~(99m)Tc-MIBI on location was 83.5%(76/91),60.9%(14/23)and 98.6%(69/70)respectively.Parathyroidectomy was performed in all but one cases,in which parathyroid carcinoma was managed by ipsilateral hemithyroidectomy and modified neck dissection.The cure rate of primary operation was 97.8%(89/91).Ninety cases were followed-up from 8 months to 14 years postoperatively,87 cases with parathyroid adenoma achieved complete remission,2 with parathyroid carcinoma suffered from tumor recurrence and 1 died.Conclusion Patients with chronic bone diseases,repeatedly recurrent nephrolithiasis,peptic ulcer disease should be a suspect of PHPT.The routine examinations of serum calcium and phosphorus are to be conducted.UItrasonography and ECT~(99m)Tc-MIBI should be considered as the methods of first choice for preoperative localization.
