【摘要】 目的分析原发性甲状旁腺功能亢进症患者再次手术的原因及相关临床特点。方法回顾性分析笔者所在医院1993年1月至2017年5月期间行手术治疗的原发性甲状旁腺功能亢进症患者中再次行手术治疗者的临床资料。结果共收集到226例行手术治疗的原发性甲状旁腺功能亢进症患者中再手术患者11例,再次手术率为5%（11/226）。其中行2次手术者8例,3次手术者2例,5次手术者1例。初次手术后病情持续3例,复发7例,有1例未定义为病情持续或复发。再次手术前患者的主要临床表现为乏力及肢体关节疼痛。再次手术的原因:异位甲状旁腺3例,甲状旁腺腺癌复发3例,甲状旁腺癌扩大切除1例,甲状旁腺双腺瘤新发2例,甲状旁腺遗漏1例,甲状旁腺增生1例。术前定位检查中行⁹⁹锝^m-甲氧基异丁基异腈甲状旁腺双时相扫描的敏感度最高（8/9）。8例选原颈部切口,3例异位甲状旁腺病变选新切口。随访时间4⁷0个月（平均23个月）,术后2例失访,1例死亡,余8例患者随访期间均无复发。结论术前综合运用影像学检查精准定位病变、由经验丰富的术者操作及熟知甲状旁腺解剖学和胚胎学,能降低甲状旁腺功能亢进症的再手术率及提高再手术成功率。更多还原

【Abstract】 Objective To analysis causes of reoperation for primary hyperparathyroidism and its clinical characteristics. Method The clinical data of the patients with primary hyperparathyroidism who had undergone reoperation from January 1993 to May 2017 were retrospectively analyzed. Results A total of 11 patients underwent reoperation were collected in the 226 patients with primary hyperparathyroidism. Of the 11 cases, 8 cases underwent twice operations, 2 cases underwent thrice operations, 1 case underwent quintic operation. After the initial operation, 3 cases were persistent diseases and 7 cases were recurrent diseases, 1 patient was not defined as the persistent or recurrent disease. The main clinical manifestations before the reoperation were fatigue, pain in joints, bones, or muscle. The reasons for reoperation included 3 cases of ectopic parathyroid lesions, 3 cases of recurrent parathyroid carcinomas, 1 case of enlarged operation extent for parathyroid carcinoma, 2 cases of regrowth of double parathyroid aedomas, 1 case of missing adenoma, 1 case of parathyroid hyperplasia. Among the location examinations, the 99 Tcm-MIBI was most sensitivity(8/9). Eight cases were received reoperation on the original incision, and the remaining 3 ectopic parathyroid lesions on the new incision. After the reoperation, 2 patients were lost of follow-up, 1 patient died, and the remaining 8 patients had no recurrences during follow-up period. Conclusion A comprehensive approach with multiple imageology examinations which attribute to accurate location of lesions, experienced surgeons and well knowledge of parathyroid anatomy and embryology help to descend reoperation ratio and improve success rate of reoperation.更多还原