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目的:探讨甲状旁腺肿瘤的诊断、术前定位、外科治疗及预后。方法:对2001年—2012年间收治的45例甲状旁腺肿瘤病例的临床资料进行回顾性分析。结果:全组45例甲状旁腺肿瘤术前均通过B超和或CT、99mTc-MIBI检查得以定位,阳性率分别为86.7%,93.8%,100%。45例均行手术治疗,均为单发肿瘤,其中左上7例,左下23例,右上4例,右下11例。术后病理证实39例为腺瘤,1例腺癌和5例囊肿。囊肿均为非功能性,腺瘤、腺癌均伴原发性甲状旁腺功能亢进(PHPT)。术前PHPT患者均有不同程度的血钙升高和血磷降低,其中24例甲状旁腺激素(PTH)升高;术后血钙明显下降,血磷明显上升(均P<0.05),1周至3个月恢复正常,PTH明显降低(P<0.05),22例术后1~5 d即正常,2例1年后正常。术中PTH(IOTPH)判断腺瘤成功切除率100%。40例获随访3个月至10年,均无复发和病灶遗漏。结论:甲状旁腺肿瘤起病缓慢,临床表现复杂多样。血钙、血磷以及血PTH的检测有助于PHPT的诊断;B超可作为甲状旁腺肿瘤的术前定位的首选检查,联合CT和99mTc-MIBI核素扫描能提高定位率;手术治疗为甲状旁腺肿瘤的首选治疗方法,效果良好。
Objective: To investigate the diagnosis, preoperative localization, surgical treatment and prognosis of parathyroid tumor. Methods: The clinical data of 45 cases of parathyroid tumor admitted from 2001 to 2012 were analyzed retrospectively. Results: All the 45 cases of parathyroid tumor were located by preoperative ultrasonography or CT, 99mTc-MIBI, the positive rates were 86.7%, 93.8% and 100% respectively. All 45 patients underwent surgical treatment. All of them were single tumors, of which 7 were upper left, 23 lower left, 4 upper right and 11 lower right. Postoperative pathology confirmed that 39 cases were adenomas, 1 adenocarcinoma and 5 cysts. Cysts are non-functional, adenomas, adenocarcinomas are associated with primary hyperparathyroidism (PHPT). Preoperative PHPT patients have varying degrees of elevated serum calcium and phosphorus decreased, of which 24 cases of parathyroid hormone (PTH) increased; postoperative serum calcium decreased significantly, serum phosphorus increased significantly (all P <0.05), 1 After 3 weeks, normal return of PTH was found (P <0.05). Normal operation occurred in 22 cases 1 ~ 5 days after operation and normal in 2 cases after 1 year. Intraoperative PTH (IOTPH) to determine the success rate of adenoma resection 100%. 40 patients were followed up for 3 months to 10 years, no recurrence and missed lesions. Conclusions: Parathyroid tumors have a slow onset and complicated and diverse clinical manifestations. Detection of serum calcium, phosphorus and blood PTH contributes to the diagnosis of PHPT; B ultrasound can be used as the first choice of preoperative localization of parathyroid tumor, CT and 99mTc-MIBI radionuclide scan can improve the positioning rate; surgical treatment is Parathyroid tumors preferred treatment, the effect is good.