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 solitary parathyroid 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 and 99mTc-MIBI are the main approachs for localization; surgery is the most effective treatment method and unilateral neck exploration is the common procedure.