CAJ | 학술논문

目的：探讨以泌尿系结石首发的原发性甲状旁腺功能亢进症（ primary hyperparathyroidism ， PHPT）的临床诊断及治疗。方法回顾性分析河南大学淮河医院近10年来收治的26例以泌尿系结石首发的PHPT的临床资料。结果本组病例中双侧上尿路结石22例，单侧4例，术前均有泌尿系统症状。彩超、CT及放射性核素检查有助于定位诊断。24例行经皮肾镜或输尿管镜气压弹道碎石术，2例输尿管结石自行排出。所有患者均行手术治疗PHPT，均经术中冰冻病理及术后常规病理检查证实诊断。术后临床症状明显改善。术前血钙、尿钙、甲状旁腺激素明显升高，术后下降，差异有统计学意义（ P＜0.05）；术前血磷明显降低，术后升高，差异有统计学意义（ P＜0.05）。结论以泌尿系结石首发的PHPT的诊断应重视实验室检测及影像学检查，手术治疗可明显降低结石复发率和改善肾功能。
목적：탐토이비뇨계결석수발적원발성갑상방선공능항진증（ primary hyperparathyroidism ， PHPT）적림상진단급치료。방법회고성분석하남대학회하의원근10년래수치적26례이비뇨계결석수발적PHPT적림상자료。결과본조병례중쌍측상뇨로결석22례，단측4례，술전균유비뇨계통증상。채초、CT급방사성핵소검사유조우정위진단。24례행경피신경혹수뇨관경기압탄도쇄석술，2례수뇨관결석자행배출。소유환자균행수술치료PHPT，균경술중빙동병리급술후상규병리검사증실진단。술후림상증상명현개선。술전혈개、뇨개、갑상방선격소명현승고，술후하강，차이유통계학의의（ P＜0.05）；술전혈린명현강저，술후승고，차이유통계학의의（ P＜0.05）。결론이비뇨계결석수발적PHPT적진단응중시실험실검측급영상학검사，수술치료가명현강저결석복발솔화개선신공능。
Objective To investigate the diagnosis and treatment of primary hyperparathyroidism ( PHPT) initially with urinary calculus .Methods The clinical data of 26 patients who diagnosed as PHPT ini-tially with urinary calculus were retrospectively reviewed .Results There were 22 cases with bilateral urinary calculus and 4 cases with unilateral relapsed urinary calculus .Ultrasonography , CT and radionuclide were helpful to determine the location of the neoplasia .24 cases underwent percutaneous nephroscope or ureteroscopy pneu-matic ballistic lithotripsy , 2 cases discharged ureteral calculi by themselves .All patients were performed surgical treatment of PHPT , which was confirmed by intraoperative frozen pathology and postoperative pathological exami -nation.There was great improvement of clinical symptoms after surgical procedures .The preoperative serum calci-um, urine calcium and parathyroid hormone elevated , while serum phosphate decreased .The postoperative indi-cators were just the opposite .The difference had statistical significance ( P<0.05 ) .Conclusions Laboratory investigations and imaging studies are very important to diagnose PHPT initially with urinary calculus .The para-thyroid surgery can remarkably reduce the calculus recurrence and improve renal function .