中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2015年
8期
686-689
,共4页
丁红英%马厚勋%邓小琴%杨秋晨
丁紅英%馬厚勛%鄧小琴%楊鞦晨
정홍영%마후훈%산소금%양추신
原发性甲状旁腺功能亢进症%诊断%治疗
原髮性甲狀徬腺功能亢進癥%診斷%治療
원발성갑상방선공능항진증%진단%치료
Primary hyperparathyroidism%Diagnosis%Treatment
目的 探讨原发性甲状旁腺功能亢进症的临床表现、延误诊断原因、诊断方案及相关治疗策略.方法 回顾性分析我院2009年1月至2014年10月收治36例原发性甲状旁腺功能亢进症患者的临床资料.结果 原发性甲状旁腺功能亢进症临床表现多样,误诊率高,达25.0％ (9/36).男:女比例为1:1,中位年龄58岁.36例首发症状中,骨关节疼痛9例、消化道(恶心,呕吐)症状7例、颈部包块6例(其中3例为B超检查时发现)、泌尿系结石5例、乏力4例、骨质疏松及泌尿系结石2例、骨折1例,无症状者2例.36例患者实验室检查,血清钙值至少1次升高,甲状旁腺激素值均升高,彩超联合CT或99Tcm-MIBI定位检查准确率分别提高到85.2％、93.1％.28例行手术治疗,病理证实甲状旁腺腺瘤23例,甲状旁腺增生1例,甲状旁腺癌l例,甲状旁腺腺瘤合并结节性甲状腺肿2例,甲状旁腺腺瘤合并甲状腺癌1例.术后患者症状改善,血清钙、甲状旁腺激素水平明显降低.另外8例未采取手术治疗,其中7例缓解,1例因难以纠正的高钙危象而死亡.结论 应提高对原发性甲状旁腺功能亢进症的识别,重视血钙检查,对疑似病例应早期行甲状旁腺素、颈部彩超等检查,早期手术治疗可明显改善预后,提高生存质量.
目的 探討原髮性甲狀徬腺功能亢進癥的臨床錶現、延誤診斷原因、診斷方案及相關治療策略.方法 迴顧性分析我院2009年1月至2014年10月收治36例原髮性甲狀徬腺功能亢進癥患者的臨床資料.結果 原髮性甲狀徬腺功能亢進癥臨床錶現多樣,誤診率高,達25.0％ (9/36).男:女比例為1:1,中位年齡58歲.36例首髮癥狀中,骨關節疼痛9例、消化道(噁心,嘔吐)癥狀7例、頸部包塊6例(其中3例為B超檢查時髮現)、泌尿繫結石5例、乏力4例、骨質疏鬆及泌尿繫結石2例、骨摺1例,無癥狀者2例.36例患者實驗室檢查,血清鈣值至少1次升高,甲狀徬腺激素值均升高,綵超聯閤CT或99Tcm-MIBI定位檢查準確率分彆提高到85.2％、93.1％.28例行手術治療,病理證實甲狀徬腺腺瘤23例,甲狀徬腺增生1例,甲狀徬腺癌l例,甲狀徬腺腺瘤閤併結節性甲狀腺腫2例,甲狀徬腺腺瘤閤併甲狀腺癌1例.術後患者癥狀改善,血清鈣、甲狀徬腺激素水平明顯降低.另外8例未採取手術治療,其中7例緩解,1例因難以糾正的高鈣危象而死亡.結論 應提高對原髮性甲狀徬腺功能亢進癥的識彆,重視血鈣檢查,對疑似病例應早期行甲狀徬腺素、頸部綵超等檢查,早期手術治療可明顯改善預後,提高生存質量.
목적 탐토원발성갑상방선공능항진증적림상표현、연오진단원인、진단방안급상관치료책략.방법 회고성분석아원2009년1월지2014년10월수치36례원발성갑상방선공능항진증환자적림상자료.결과 원발성갑상방선공능항진증림상표현다양,오진솔고,체25.0％ (9/36).남:녀비례위1:1,중위년령58세.36례수발증상중,골관절동통9례、소화도(악심,구토)증상7례、경부포괴6례(기중3례위B초검사시발현)、비뇨계결석5례、핍력4례、골질소송급비뇨계결석2례、골절1례,무증상자2례.36례환자실험실검사,혈청개치지소1차승고,갑상방선격소치균승고,채초연합CT혹99Tcm-MIBI정위검사준학솔분별제고도85.2％、93.1％.28례행수술치료,병리증실갑상방선선류23례,갑상방선증생1례,갑상방선암l례,갑상방선선류합병결절성갑상선종2례,갑상방선선류합병갑상선암1례.술후환자증상개선,혈청개、갑상방선격소수평명현강저.령외8례미채취수술치료,기중7례완해,1례인난이규정적고개위상이사망.결론 응제고대원발성갑상방선공능항진증적식별,중시혈개검사,대의사병례응조기행갑상방선소、경부채초등검사,조기수술치료가명현개선예후,제고생존질량.
Objective To explore the clinical manifestations,diagnosis,misdiagnosis and treatment of primary hyperparathyroidism.Methods The clinical data of 36 patients with primary hyperparathyroidism admitted into the First Affiliated Hospital of Chongqing Medical University from January 2009 to October 2014 were reviewed and analyzed retrospectively.Results The manifestations of primary hyperparathyroidism were various and atypical.Primary hyperparathyroidism was often misdiagnosed as other diseases by 25.0％ (9/36).Among the patients,the ratio of male to female was 1:1,and median age was 58 years old.Of all patients,there were 9 persons with joint pain,digestive system symptoms in 7 cases,cervical mass discovered in 6 cases(3 cases were found when B ultrasonic examination),urinary calculus in 5 cases,fatigue symptoms in 4 cases,osteoporosis and urinary calculus in 2 cases,1 case with fracture,2 cases without any symptoms.Their calcium and parathyroid hormone level were increased by various degree.The accuracy rates of level diagnosis of Color Doppler ultrasound combine with CT or 99Tcm-MIBI were improved obviously,85.2％ and 93.1％ respectively.Twenty-eight patients received surgical treatment and pathology examination confirmed the accurate pathological types after surgery.There were 23 cases of parathyroid adenoma,1 case parathyroid hyperplasia,1 case parathyroid carcinoma,2 cases of parathyroid adenoma with nodular goiter,parathyroid adenoma merged thyroid carcinoma in 1 case.Serum calcium and parathyroid hormone level declined obviously after operation.The other 8 patients received non-surgical treatment,7 cases were alleviated and 1 case died due to irreformable high blood calcium crisis.Conclusion There should be pay attention to recognize primary hyperparathyroidism,check the blood calcium,and about suspected cases should be performed as early as parathyroid tested,neck color Doppler ultrasound.Early surgical treatment can significantly improve the prognosis and quality of life.
