CAJ | 학술논문

目的探讨原发性甲状旁腺功能亢进(primary hyperparathyroidism,PHPT)的漏诊预防及其外科治疗方法.方法回顾性分析承德医学院附属医院及河北医科大学第四医院自2008年7月至2013年1月收治的26例PHPT手术患者的临床资料,对术前诊断、手术方式进行分析.术前均检测血钙及甲状旁腺素(parathyroid hormone,PTH),继行彩色超声波(简称彩超)、CT及99m锝-甲氧基异丁基异腈(99mTc-methoxy isobutylis onitrile,99mTc-MIBI)扫描检查确诊PHPT并定位,经药物治疗使血钙、PTH正常后接受手术治疗.结果术中切除病变腺体后10 min快速检测PTH,其中1例PTH较术前下降不到50％,经再探查发现另一腺体病变后切除,26例均在PTH下降50％以上后终止手术.术后病理诊断甲状旁腺腺瘤23例,甲状旁腺增生2例,甲状旁腺腺癌1例.术后血钙及PTH均降至正常水平,无术后长期并发症,随访6个月至5年未见复发.16例有症状型患者10例原继发症状消失,6例改善.结论对体检或疑诊PHPT者应行血钙、PTH及甲状腺彩超检查,阳性者彩超结合CT及99mTc-MIBI定位可减少PHPT漏诊率.术中运用快速PTH测定,可减少手术探查范围,缩短手术时间.
목적 탐토원발성갑상방선공능항진(primary hyperparathyroidism,PHPT)적루진예방급기외과치료방법.방법 회고성분석승덕의학원부속의원급하북의과대학제사의원자2008년7월지2013년1월수치적26례PHPT수술환자적림상자료,대술전진단、수술방식진행분석.술전균검측혈개급갑상방선소(parathyroid hormone,PTH),계행채색초성파(간칭채초)、CT급99m득-갑양기이정기이정(99mTc-methoxy isobutylis onitrile,99mTc-MIBI)소묘검사학진PHPT병정위,경약물치료사혈개、PTH정상후접수수술치료.결과 술중절제병변선체후10 min쾌속검측PTH,기중1례PTH교술전하강불도50％,경재탐사발현령일선체병변후절제,26례균재PTH하강50％이상후종지수술.술후병리진단갑상방선선류23례,갑상방선증생2례,갑상방선선암1례.술후혈개급PTH균강지정상수평,무술후장기병발증,수방6개월지5년미견복발.16례유증상형환자10례원계발증상소실,6례개선.결론 대체검혹의진PHPT자응행혈개、PTH급갑상선채초검사,양성자채초결합CT급99mTc-MIBI정위가감소PHPT루진솔.술중운용쾌속PTH측정,가감소수술탐사범위,축단수술시간.
Objective To investigate the causes of misdiagnosis and the surgical treatment of primary hyperparathyroidism (PHPT).Methods The clinical data of 26 patients with PHPT from July 2008 to January 2013 in The Affiliated Hospital of Chengde Medical College and The Fourth Hospital of Hebei Medical University were retrospectively analyzed,including preoperative diagnosis and operative method.The level of serum calciumion and serum parathyroid hormone (PTH),Ultrasonography,CT,99mTc-methoxy isobutylis onitrile (99mTc-MIBI) were used in the diagnosis before operation.All patients accepted surgical treatment after the level of serum calciumion decreased to normal.Results The level of PTH was examined 10 min after resection,which declined more than 50％.After pathological examination,23 cases were diagnosed as parathyroid adenoma,2 cases were parathyroid hyperplasia,and 1 case was parathyroid carcinoma.The level of serum calciumion and serum parathyroid hormone were returned to the normal level after operation.All patients recovered with no postoperative complication.Followed up lasted from 6 months to 5 years,no case recurred.Sixteen cases with symptoms experienced significant improvement in signs,including 10 cases with clinical symptoms completely disappeared.Conclusions The test of serum calciumion and serum PTH,Ultrasonography,CT,99mTc-MIBI are helpful to reduce the misdiagnose rate of primary hyperparathyroidism before operation.The examination of serum parathyroid hormone in operation is helpful to reduce the operation range and time.