【摘要】 目的比较异位和原位甲状旁腺病变的临床特点和治疗效果。方法回顾性分析北京积水潭医院于2010年5月至2017年5月期间收治的136例行手术治疗的甲状旁腺病变患者的临床资料。结果 136例患者中,有20例异位甲状旁腺病变病例,异位甲状旁腺病变发生率为14.7%（20/136）,其中上纵隔异位率为30.0%（6/20）,甲状腺胸腺韧带异位率为20.0%（4/20）,胸腺异位率为15.0%（3/20）,气管食管沟异位率为25.0%（5/20）,下颌下和颈动脉鞘异位率均为5.0%（1/20）。异位甲状旁腺病变患者术前的甲状旁腺激素（PTH）和碱性磷酸酶（AKP）水平较原位患者高（P≤0.05）,且合并纤维囊性骨炎的比例也较原位患者高（P=0.04）。B超定位异位甲状旁腺病变的灵敏度为50.0%（10/20）,定位原位甲状旁腺病变的灵敏度为90.1%（100/111）;⁹⁹锝^m-甲氧基异丁基异腈(⁹⁹Tc^m-MIBI)检查定位异位甲状旁腺病变的灵敏度为100%（19/19）,定位原位甲状旁腺病变的灵敏度为95.3%（101/106）;颈部CT检查定位异位甲状旁腺病变的灵敏度为81.3%（13/14）,定位原位甲状旁腺病变的灵敏度为93.6%（102/109）。联合检查定位异位甲状旁腺病变的灵敏度为100%（20/20）,定位原位甲状旁腺病变的灵敏度为99.1%（108/109）。20例异位甲状旁腺病变患者中,17例（85.0%）行1次手术,2例（10.0%）行2次手术,1例（5.0%）行3次手术,术后13例（65.0%）出现低钙血症;116例原位甲状旁腺病变患者中,1例行2次手术,其余均行1次手术,术后74例（63.8%）出现低钙血症。异位组的再手术率高于原位组（P=0.01）,但2组术后低钙血症的发生率比较差异无统计学意义（P=0.92）。136例患者中有111例患者获访,其中异位甲状旁腺病变患者获访17例,原位甲状旁腺病变患者获访94例,获访患者随访期间均无甲状旁腺功能亢进复发。结论异位甲状旁腺病变患者术前的血PTH和AKP水平,以及合并纤维囊性骨炎的比例较原位甲状旁腺病变患者高,且再手术率也较高。对甲状旁腺病变（包括原位和异位）,联合检查的效果较好;手术方式以甲状旁腺病变切除术为主,术后患者容易出现低钙血症。更多还原

【Abstract】 Objective To compare the clinical features and surgical effect between ectopic and orthotopic parathyroid lesions. Methods The clinical data of 136 patients with parathyroid lesions who had undergone parathyroidectomy between May 2010 and May 2017 were retrospectively analyzed. Results The ectopic parathyroid location was detected in 20 patients（14.7%） of the 136 patients with parathyroid lesions. Of the 20 patients, prevalence of superior mediastinal ectopic lesions accounted for 30.0%（6/20）, prevalence of thyrothymic ligament accounted for 20.0%（4/20）, prevalence of intrathymic accounted for 15.0%（3/20）, prevalence of tracheoesophageal groove accounted for 25.0%（5/20）, prevalence of submandibular accounted for 5.0%（1/20）, prevalence of carotid sheath accounted for 5.0%（1/20）,respectively. Patients with ectopic lesions had significantly higher level of serum parathyroid hormone（PTH） and alkaline phosphatase（AKP） than patients with orthotopic parathyroid lesions（P≤0.05）. In addition, osteitis fibrosa cystica of metabolic bone disease was significantly more frequent in patients with ectopic parathyroid lesions than those with orthotopic parathyroid lesions（P=0.04）. Preoperative ultrasonography had a sensitivity of 50.0%（10/20） for ectopic lesions and 90.1%（100/111） for orthotopic lesions. Preoperative ⁹⁹Tc^m methoxyisobutylisonitrile(⁹⁹Tc^m-MIBI) had a sensitivity of 100%（19/19）for ectopic lesions and 95.3%（101/106） for orthotopic lesions. Preoperative CT had a sensitivity of 81.3%（13/14） for ectopic lesions and 93.6%（102/109） for orthotopic lesions. Preoperative combination examination had a sensitivity of 100%（20/20） for ectopic lesions and 99.1%（108/109） for orthotopic lesions. Of the 20 patients with ectopic leisions, 17 patients（85.0%） had undergone 1 time of operation, 2 patients（10.0%） had undergone twice operations, 1 patient（5.0%） had undergone trice operations. The onset of hypocalcemia happened in 13 patients（65.0%） after operation. Of 116 patients with orthotopic leisions, only 1 patient had twice operations, the onset of hypocalcemia happened in 74 patients（63.8%） after operation. The reoperation rate of orthotopic leisions was lower than that of patients with ectopic leisions（P=0.01）, but there was no significant difference on the incidence of hypocalcemia（P=0.92）. Excessive bleeding and recurrent laryngeal nerve injury didn’t happen after all operations. Of 136 patients,111 patients had followed-up, among which 17 patients with ectopic leisions and 94 patients with orthotopic leisions.During the followed-up period, there were no recurrence happened. Conclusions The ectopic parathyroid lesions are associated with higher serum PTH and AKP levels and more frequent metabolic bone disease in comparison with the orthotopic parathyroid lesions, as well as high reoperation rate. Combined examination, including cervical ultrasonography, ⁹⁹Tc^m-MIBI, and cervical enhanced CT are needed for preoperative location. Parathyroid lesions resection is the main surgical approach, and patients with parathyroid lesions are prone to be onset of hypocalcemia.更多还原