目的 总结原发性甲状旁腺功能亢进症的诊治体会。方法 回顾性分析本院普通外科2015年1月至2017年11月经手术治疗的138例原发性甲状旁腺功能亢进症病人的临床资料。结果 138例病人,男30例,女108例,均行手术治疗,其中甲状旁腺危象5例,1例行急诊手术治疗。切除病变甲状旁腺150枚。术后病理检查显示：123枚（82.0%）为甲状旁腺腺瘤,9枚（6.0%）为甲状旁腺增生,4枚（2.7%）为甲状旁腺癌,10枚（6.6%）为甲状旁腺囊肿,4枚（2.7%）为甲状旁腺非典型腺瘤。术后第1天甲状旁腺素（parathyroid hormone, PTH）均降至正常,血钙下降。其中48例术后出现低血钙症状,经补充活性维生素D和葡萄糖酸钙,恢复正常。无喉返神经损伤等并发症发生。结论 血钙和PTH可作为原发性甲状旁腺功能亢进的初步诊断方法。甲状旁腺切除术是有效治疗手段。术前准确定位有助于缩小探查范围。对于甲状旁腺危象,给予水化利尿及双膦酸盐降钙治疗、及时早期行甲状旁腺切除术,可取得良好治疗效果。
Objective To summarize the experience in the diagnosis and treatment of primary hyperparathyroidism (PHPT). Methods The clinical data of 138 patients with PHPT who underwent parathyroidectomy in our hospital from January 2015 to November 2017 were analyzed retrospectively. Results The patients including 30 males and 108 females were all treated with surgical treatment. Five cases had parathyroid crisis and 1 case underwent emergent surgery. A total of 150 parathyroid glands were resected. Postoperative pathology confirmed that 123 (82.0%) lesions were parathyroid adenoma, 9 (6.0%) lesions parathyroid hyperplasia, 4 (2.7%) lesions parathyroid carcinoma, 10 (6.6%) lesions parathyroid cysts and 4(2.7%) lesions parathyroid atypical adenoma. Parathyroid hormone decreased to normal and the blood calcium decreased in all cases after parathyroidectomy. The symptoms of hypocalcemia were found in 48 cases whose blood calcium restored to normal after supplementation of active vitamin D and calcium gluconate. There were no recurrent laryngeal nerve injury and other complications. Conclusions Blood calcium and parathyroid hormone can be used in the diagnosis of PHPT in early stage. Parathyroidectomy is an effective treatment for PHPT. Preoperation precise localization is helpful for the exploration of pathological lesion. Management with hydration diuresis and bisphosphonates and early parathyroidectomy have good effect on parathyroid crisis.
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