-
摘要: 目的:探讨甲状旁腺占位性病变的临床表现、诊断和治疗方法。方法:回顾性分析我院2003-01-2012-10期间收治的26例甲状旁腺占位性病变患者的临床资料。结果:26例患者中,甲状旁腺腺癌2例,甲状旁腺腺瘤11例,甲状旁腺囊肿13例。临床表现除13例为囊肿外,均伴有甲状旁腺功能亢进症状,其中颈部肿物26例,骨质疏松或骨纤维囊性变11例,泌尿系统症状9例,消化系统症状8例。定性诊断依赖于血钙及甲状旁腺激素(PTH)水平的测定。术前定位检查主要依靠B超、CT、MRI等影像学手段。2例甲状旁腺腺癌患者、11例甲状旁腺腺瘤患者和13例甲状旁腺囊肿患者术前与术后诊断符合率分别为0(0/2)、91%(10/11)、69%(9/13)。所有患者均行手术治疗,2例甲状旁腺腺癌患者术后分别随访17个月和27个月均无瘤生存;11例甲状旁腺腺瘤患者手术治疗后,症状缓解,均未见复发;13例甲状旁腺囊肿患者术后均未见复发。结论:甲状旁腺占位性病变缺乏特异性临床表现,颈部肿物为常见表现。血清钙离子及PTH水平的测定结合B超、CT、MRI和99mTc-MIBI等影像学有助于甲状旁腺占位性病变的诊断。甲状旁腺腺癌术前诊断困难。甲状旁腺占位性病变确诊主要依靠病理学诊断。手术为甲状旁腺占位性病变的首选治疗方式。Abstract: Objective:To investigate the clinical manifestation,diagnosis,treatment of parathyroid occupying lesions.Method:The clinical data of 26 patients with parathyroid occupying lesions between January 2003 and October 2012 at Dalian Central Hospital were retrospectively analyzed.Result:There were 2 cases of parathyroid cancer,11 cases of parathyroid adenoma,13 cases of parathyroid cysts in this study. All the cases,except 13 cases of cysts,are accompanied by symptoms of hyperparathyroidism.The symptoms were as follows:26 cases of neck lump,11 cases of osteoporosis/osteitis fibrosa cystica,9 cases of urinary symptom,8 cases of digestive symptom.Serum calciumion level and serum parathyroid hormone(PTH) level were examined qualitatively before operation.Ultrasonography,CT,MRI were used in diagnosing and locating parathyroid occupying lesion before operation. 2 cases of parathyroid cancer,11 cases of parathyroid adenoma and 13 cases of parathyroid cysts with preoperative and postoperative diagnosis coincidence rate was 0(0/2),91% (10/11),69% (9/13).All patients were treated with operation.2 cases of parathyroid cancer survived with out recurrence during follow up for 17 months and 27 months after operation.11 cases of parathyroid adenoma and 13 cases of parathyroid cysts were treated with operation,achieved complete remission and the outcome was no recurrence.Conclusion:There lack of specific clinical symptoms of parathyroid occupying lesions,neck lump are common manifestations. Examination of serum calcium and PTH level together with ultrasonography,CT,MRI,99mTc-MIBI is helpful to diagnose parathyroid occupying lesions. Parathyroid cancer preoperative diagnosis is difficult. Parathyroid occupying lesions determine the diagnosis depends on pathology.Surgery should be done as primary treatment.
-
Key words:
- parathyroid neoplasms /
- diagnosis /
- parathyroidectomy
-
[1] LIM S, ELSTON M S, GILL A J, et al.Metastatic parathyroid carcinoma initially misdiagnosed as parathyroid adenoma:the role of parafi parafibromin in increasing diagnostic accuracy[J].Int Med J, 2011, 41:695-699.
[2] GROSSO I, SARGIOTTO A, D'AMELIO P, et al.Preoperative localization of parathyroid adenoma with sonography and 99mTc-sestamibi scintigraphy in primary hyperparathyroidism[J].J Clin Ultrasound, 2007, 35:186-190.
[3] 陈隽, 王家东.巨大甲状旁腺瘤一例[J].中华耳鼻咽喉头颈外科杂志, 2011, 46 (3):241-242.
[4] 刘方舟, 董明敏, 张园, 等.非功能性甲状腺囊肿临床分析[J].临床耳鼻咽喉头颈外科杂志, 2008, 22 (21):982-983.
[5] 施秉银, 唐楠, 高慧, 等.细针抽吸诊断和治疗甲状旁腺囊肿13例报道[[J].中华内分泌代谢杂志, 1998, 14 (4):239-239.
[6] PELIZZO M R, PAGETTA C, PIOTTO A, et al.Surgical treatment of primary hyperparathyroidism:from bilateral neck exploration to minimally invasive surgery[J].Minerva Endocrinol, 2008, 33:85-93.
[7] 陈秀梅, 张庆泉.甲状旁腺良性肿瘤临床分析[J].中华耳鼻咽喉头颈外科杂志, 2010, 45 (12):1041-1042.
[8] 魏伯俊, 申虹, 王佳, 等.肿瘤性甲状旁腺功能亢进的手术治疗[J].中华耳鼻咽喉头颈外科杂志, 2012, 47 (10):861-864.
[9] 张永兰, 王家东.原发性甲状旁腺功能亢进术中甲状旁腺激素检测的应用[J].临床耳鼻咽喉头颈外科杂志, 2011, 25 (4):190-192.
[10] 陈隽, 王家东.甲状旁腺及其周围组织在99mTc-MIBI引导的甲状旁腺切除术中放射性差异的研究[J].中华耳鼻咽喉头颈外科杂志, 2012, 47 (9):739-742.
计量
- 文章访问数: 28
- PDF下载数: 68
- 施引文献: 0