甲状旁腺功能亢进症的诊断和治疗
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丁洪飞 E-mail:gdyfywjk@163.com

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Diagnosis and treatment of hyperparathyroidism
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    摘要:

    目的:探讨原发性甲状旁腺功能亢进症(PHPT)和继发性甲状旁腺功能亢进症(SHPT)的诊断及治疗方法。
    方法:回顾性分析我院19年间收治的15例PHPT和26例SHPT患者的临床资料,诊断依靠血清学、影像学、99mTc-MIBI及临床表现;按病情不同行手术和非手术治疗。
    结果:41例患者的血清甲状旁腺激素(PTH)均升高,PHPT的血钙水平升高,SHPT的血钙水平降低。彩超、99mTc-MIBI定位诊断准确率分别为73.17% 和85.71%。行手术治疗的15例PHPT和3例SHPT患者术后均无复发;非手术治疗的23例SHPT患者均能缓解病情进展。
    结论: PTH和血钙是HPT定性诊断的主要依据,定位诊断首选彩超、99mTc-MIBI。PHPT以外科手术治疗为主;SHPT以非手术治疗为主,非手术治疗无效者可行手术治疗。

    Abstract:

    Objective:To explore the diagnosis and treatment of primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism (SHPT).
    Methods:The clinical data of 15 PHPT patients and 26 SHPT patients admitted to our hospital in 19 years were analyzed. Diagnosis relied on serology, imaging, 99mTc-MIBI and clinical manifestations. Patients were given surgical and non-surgical treatment according to the different conditions.
    Results:Serum parathyroid hormone (PTH) of 41 patients was elevated, serum calcium of PHPT patients was elevated, and serum calcium of SHPT patients was reduced. Ultrasonography and 99mTc-MIBI in diagnostic accuracy was 73.17% and 85.71% respectively.  Fifteen patients with PHPT and 3 patients with SHPT underwent surgery, with no one case of recurrence. Twenty-three patients with SHPT underwent non-surgical treatment, with alleviation of disease process in all cases.
    Conclusions:PTH and serum calcium is the main basis for qualitative diagnosis of HPT, localization diagnosis relies on Ultrasonography and 99mTc-MIBI. Surgical treatment is effective for PHPT. Patients with SHPT can mainly undergo non-surgical treatment, and choose surgery only when non-surgical treatment is ineffective.

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丁洪飞| 黄胜超| 陈国珍| 陈小东| 李建文| 张远起| 黄水传| 张智| 肖雄升.甲状旁腺功能亢进症的诊断和治疗[J].中国普通外科杂志,2010,19(11):1187-1191.
DOI:10.7659/j. issn.1005-6947.2010.11.007

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  • 收稿日期:2010-03-20
  • 最后修改日期:2010-10-15
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  • 在线发布日期: 2010-11-15