【摘要】 目的:探讨原发性甲状旁腺功能亢进症(PHPT)的外科诊治经验。方法:回顾性分析2002—2012年间收治的86例PHPT患者的临床资料。结果:首发症状表现为骨骼系统病变45例,泌尿系统症状21例,消化道症状14例;无症状者6例。术前86例患者平均血钙浓度(3.13±0.46)mmol/L,甲状旁腺素(PTH)中位浓度864.6 pmol/mL。B超检出率90.3%,99mTc-MIBI检出率95.0%,CT检出率78.6%。58例单纯单发甲状旁腺瘤(其中包括异位甲状旁腺腺瘤5例)行单侧颈部探查术;11例双侧甲状旁腺腺瘤,15例单发甲状旁腺腺瘤合并双侧结节性甲状腺肿,2例甲状旁腺增生行双侧颈部探查术。术后成功随访80例,时间3个月至6年,所有患者均无复发。结论:血钙、血PTH是PHPT定性诊断的主要依据,B超、99mTc-MIBI是PHPT主要定位手段。手术治疗是最有效的方法,单侧颈部探查术是常用术式。更多还原

【Abstract】 Objective: To investigate the surgical diagnosis and treatment of primary hyperparathyroidism(PHPT). Methods: The clinical data of 86 PHPT patients treated between 2002 and 2012 were retrospectively analyzed. Results: Of the patients, the initial symptoms presented in 45 cases as skeletal disorders, in 21 cases as urological problems, and in 14 cases as gastrointestinal upsets; six cases had no obvious symptoms. The mean calcium level was(3.13±0.46) mmol/L and the median parathyroid hormone(PTH) level was 864.6 pg/mL in patients before operation. The detection rate of diseases by ultrasound,99mTc-MIBI, and CT was 90.3%, 95.0% and 78.6%, respectively. Unilateral neck exploration was performed in 58 patients with a solitaryparathyroid adenoma(including 5 cases of ectopic parathyroid adenoma), and bilateral neck exploration was performed in 11 patients with multiple parathyroid adenomas, 15 patients with parathyroid adenoma combined with bilateral nodular goiter and 2 patients with parathyroid hyperplasia. Eighty cases were followed up for 3 months to six years, and all of them survived without recurrence. Conclusion: For PHPT, the calcium and PTH levels are the bases for qualitative diagnosis; ultrasound and99mTc-MIBI are the main approachs for localization; surgery is the most effective treatment method and unilateral neck exploration is the common procedure.更多还原