【作者】 韩先龙；

【导师】 殷朔；

【作者基本信息】 大连医科大学 ， 普通外科学， 2011， 硕士

【摘要】 目的:了解甲状旁腺肿瘤的临床特点,分析外科治疗的效果。方法:收集我院2002年1月-2011年2月收治的43例甲状旁腺肿瘤病人临床资料,回顾性分析甲状旁腺肿瘤临床特点及外科治疗效果。结果:本组病例中,甲状旁腺腺瘤29例（67.4%）,甲状旁腺囊肿13例（30.2%）,甲状旁腺癌1例（2.32%）,除13例囊肿外,均伴有甲状旁腺功能亢进症状,主要表现为颈部肿物、骨折、骨痛、泌尿系结石、恶心呕吐乏力等,入院后行生化血液检查发现高钙血症及高PTH血症,余16例病人中骨骼、关节病变8例;泌尿系结石病变1例;顽固性恶心呕吐5例;骨骼病变伴恶心呕吐乏力1例;骨和泌尿系结石病变1例。术前定位检查主要依靠B超、CT、^99mTC-MIBI等手段,诊断准确率分别为68.5%、76.4%、75%;定性诊断依赖于血钙、血磷及甲状旁腺素（PTH）等水平的测定,本组病例中,除13例甲状旁腺囊肿外,其余30例（29例甲状旁腺腺瘤+1例甲状旁腺癌）血钙均高于正常（2.1-2.6mmol/L）,其中最低为2.79 mmol/L,最高达3.85mmol/L;26例血清磷检测低于正常（0.96-1.62mmol/L）;甲状旁腺素（PTH）检测均高于正常（15-65 mmol/L）。对伴有甲状旁腺功能亢进的30患者手术后再次行生化血液检查,发现血钙及甲状旁腺素均有明显的降低,而血磷则有一定程度的回升,且大多数患者手术后均出现不同程度的低血钙症状,如口周麻木,手足发麻等,经静脉注射葡萄糖酸钙或口服钙剂后,血钙均在1周-3个月恢复至正常范围。43例患者均行手术治疗,29例甲状旁腺腺瘤18例行甲状旁腺腺瘤切除术,11例行甲状旁腺腺瘤及甲状腺叶部分切除术,均为单侧甲状旁腺探查术。13例甲状旁腺囊肿中12例单纯行囊肿切除,1例行囊肿及对侧甲状腺肿物切除术。1例甲状旁腺癌行甲状旁腺肿瘤+同侧甲状腺+峡部+同侧甲状旁腺探查术。30例甲状旁腺功能亢进患者术后症状缓解,随访未见复发。甲状旁腺癌1例术后随访1年5个月,未见肿瘤复发迹象。结论:甲状旁腺肿瘤缺乏特异性临床症状,对有骨关节疼痛、反复发作的泌尿系结石、顽固性恶心呕吐等表现的病人,临床医生应高度警惕甲状旁腺肿瘤存在可能。血钙、血磷及血甲状旁腺素测定是可靠的定性诊断方法,定位检查首选B超,必要时可结合CT、^99mTC-MIBI检查。手术切除是甲状旁腺肿瘤的最佳治疗方法;甲状旁腺囊肿可仅行单纯肿物切除术,而对术前定位准确的甲状旁腺腺瘤结合术中冰冻病理检查行单侧甲状旁腺探查是可行的;早期甲状旁腺癌应同时切除同侧甲状腺腺叶、峡部及周围软组织,不主张行预防性颈淋巴结清扫术,对术前已确诊有颈淋巴结转移或者术后复发的患者则应行扩大切除术。更多还原

【Abstract】 Objective:To reveal the clinical characteristics of parathyroid tumors and analysis its surgical therapy effect.Methods: The follow-up data of 43 cases of parathyroid tumors received treatment in general surgery ward of The First Affiliated Hospital to Dalian Medical University from January 2002 to February 2011 were enrolled into retrospective analysis.Results: This research involve 29 cases of parathyroid adenomas（67.4%）,13 cases of parathyroid cysts（30.2%）and 1 case of parathyroid cancer （2.32%）.All the cases,except 13 cases of cysts, are accompanied by symptoms of hyperparathyroidism, which mainly characterized by neck mass, fracture, bone pain,urinary calculi, nausea ,vomiting and fatigue, etc,and show the clinical symptoms of hypercalcemia and high parathyroid hormone（PTH） levels without hyperparathyroidism;8 cases are characterized by bone and joint lesions;1 case is characterized by urinary calculi;5 cases are characterized by intractable nausea and vomiting;1 case is mixed with the symptoms of bone lesions and nausea,vomiting,fatigue;1 case is mixed with the symptoms of osseous and urinary calculi.It’s depended on ultrasonic imaging,CT scan and ^99mTC-MIBI for preoperative positioning,of which diagnostic accuracy respectively are 68.5%,76.4% and 75%;The laboratory examinations of blood calcium, phosphate and PTH are needed for qualitative diagnosis.In this research,the blood calcium of 30 cases（29 cases of parathyroid adenomas and 1 case of parathyroid cancer）is higher than normal level（2.1-2.6mmol/L）,of which the lowest level is 2.79 mmol/L,and the highest level is 3.85mmol/L;The blood phosphate of 26 cases is lower than the normal level（0.96-1.62mmol/L）;PTH of all cases is higher than normal level（15-65 mmol/L）. The biochemical blood test of the cases accompnied by hyperparathyroidism after surgical therapy shows that blood calcium and PTH level falls with the blood phosphate level climbs to a certain extent,and most patients manifest the symptoms of hypocalcemia,such as peri-mouth and extremity numbness,whose blood calcium can rise to the normal level when received calcium gluconate injection or oral calcium taking during 1 weeks to 3 moths after the surgery.46 patients all have received surgical theray.Amone the 29 cases of parathyroid adenomas received parathyroid adenoma resection,11 cases received lobectomy of thyroid at the same time after a unilateral parathyroid exploration.Amone the 13 cases of parathyroid cysts received cystectomy,1 case received excision of the contralateral thyroid tumor. 1 case of parathyroid cancer received exploratory operation of parathyroid tumor,homolateral parathyroid,isthmus and homolateral lobe of thyroid.30 cases manifested hyperparath- yroidism are without recurrence and get relieved after the surgery.1 case of parathyroid cancer which was followed up for one year and 5 months showed disease-free survival.Conclusion: 1.There lack of specific clinical symptoms of parathyroid tumors.Clinicians should be alert of the patients suffered from bone and joint pain,repeated attacks of urinary calculi and intractable nausea and vomiting. 2. The laboratory examinations of blood calcium, phosphate and PTH are reliable for qualitative diagnosis.B-ultrasonic imaging is preferred in preoperative positioning,how- ever CT and ^99mTC-MIBI scan can be applied when necessary. 3.Surgical resection is the predominant therapy for parathyroid tumors,simple cystectomy is enough for parathyroid cysts,it’s feasible to perform a unilateral parathyroid exploratory operation for parathyroid adenomas with an accurate preoperative positioning and a intraoperative frozen section.For early stage of parathyroid cancer,it’s recommended to perform an excision of isthmus and homolateral lobe of thryroid,peripheral soft tissues should be included.Prophylactic neck dissection is not advisable,however extensive resection is necessary for the cases with cervical lymph node metastasis or post-surgical recurrence.更多还原