原发性甲状旁腺功能亢进症的定位诊断与手术治疗
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袁时芳

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Diagnostic localization and surgical treatment of primary hyperparathyroidism
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    摘要:

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    目的 探讨原发性甲状旁腺功能亢进症的定位诊断与治疗方法。
    方法 回顾性分析近15年来手术治疗的52例原发性甲状旁腺功能亢进症患者的临床资料。
    结果 所有病例均在术前行B超和X线检查,99mmTcMIBI核素扫描36例,所有病例均术中静脉快速滴注亚甲蓝。行甲状旁腺腺瘤切除术45例(小切口腺瘤切除18例),甲状旁腺增生切除术4例,根治性甲状旁腺癌切除术3例。病理性骨折18例,骨、关节痛22例,泌尿系结石病变6例,无症状者6例。X线检查全组患者均表现为骨质疏松。全组血钙升高在2.7~4.3mmol/L之间,平均(3.0±0.5)mmol/L。38例患者术前测定甲状旁腺激素升高在305~1 813pg/mL之间,平均(628.3±87.6)pg/mL。B超术前定位诊断率82.6%,99mmTcMIBI核素扫描的定位诊断率88.9%,术中静滴亚甲蓝染色定位诊断率96.2%。术后36例患者出现短期低血钙,24例出现面部、手足麻木,12例出现手足抽搐,经钙剂治疗血钙恢复正常。患者术后甲状旁腺激素均恢复正常,3例甲状旁腺癌患者术后升高,经再次手术恢复正常。45例获随访,随访时间3个月至15年,临床症状缓解,骨质疏松改善,骨折愈合。
    结论 小创伤甲状旁腺切除是治疗原发性甲状旁腺功能亢进症的有效方法。术中亚甲蓝染色结合术前B超、核素扫描定位诊断原发性甲状旁腺功能亢进症,使甲状旁腺肿瘤切除术准确和微创。

    Abstract:

    Abstract:Objective To investigate the diagnostic localization and surgical treatment of primary hyperparathyroidism(pHPT). 〖JP〗
    Methods The clinical data of 52 patients who diagnosed as pHPT and underwent parathyroidectomy at Xijing Hospital between January, 1990 and June, 2005 were retrospectively reviewed.
    Results Preoperative ultrasound and Xray examination were performed in all patients, 99m TCMIBI imaging were used in 36 patients and 52 patients using the intraoperative Vital blue technique for operative localization. Pathological bone fractures occurred in 18 cases. Skeletal manifestations were found in 22 cases and urinary stones in 6 cases. Six patients were asymptomatic. Hypercalcemia was detected in all patients with the average value of (3.0±0.5) mmol/L, ranging from 2.7 to 4.3 mmol/L. Thirtyeight patients 〖JP+1〗showed elevated parathyroid hormone (PHT) with the average value of(628.3±87.6)pg/mL, ranging

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袁时芳,马中,姚青,凌瑞,黄育勉,王岭.原发性甲状旁腺功能亢进症的定位诊断与手术治疗[J].中国普通外科杂志,2007,16(1):9-.
DOI:10.7659/j. issn.1005-6947.2007.01.009

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  • 收稿日期:2006-05-31
  • 最后修改日期:2006-10-20
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  • 在线发布日期: 2007-01-25