骨病型甲状旁腺腺瘤的诊断和治疗

目的 介绍甲状旁腺腺瘤早期诊断的新技术及外科治疗经验。方法 通过对1986年11月～2000年8月9例经手术治疗的甲状旁腺腺瘤患者临床资料分析，结合文献复习，进行诊治经验总结。其中男3例，女6例，年龄12～55岁，平均32岁。平均病程4年9个月。患者均有普遍性骨皮质密度降低，骨膜下骨质吸收。3例有多部位骨囊性病变；5例有陈旧性骨折，提示有骨性并发症，其中2例同时有泌尿系结石。术前1例儿童跛行，8例丧失劳动力。检测血清甲状旁腺激素(PTH)5例，均显著升高(633．87～1017．40pmol／L，正常值：28．50～90．50pmol／L)，甲状旁腺核素扫描3例腺瘤均显像。结果 7例经颈部完成甲状旁腺腺瘤手术切除；2例甲状旁腺腺瘤位于胸内，经胸骨切开完成肿瘤切除手术。9例均经病理学诊断证实为甲状旁腺腺瘤，均获2～16年随访，无复发。患者骨痛缓解，行动自如，PTH正常，X线片显示骨折愈合，骨病损明显减轻。结论 ①血清PTH检测作为此病较新诊断技术具有特殊意义，可鉴别诊断高钙血症的病因，多普勒彩超及核素甲状旁腺腺瘤显像可以作出定位诊断；②术中肉眼直视下识别甲状旁腺及其是否正常为重要的一环，术中冰冻切片检查不可缺少；③切除肿瘤的同时须确保留下正常甲状旁腺组织，以维持正常甲状旁腺功能；④外科治疗中不能忽略异位甲状旁腺，并应认识到甲状旁腺数目可少于或多于4个的这种数量改变；⑤甲状旁腺腺瘤手术治疗近期和远期疗效满意。

DIAGNOSIS AND TREATMENT OF OSTEOPATHIC PARATHYROID ADENOMA

Objective To introduce the advanced diagnostic technologies and share the surgical experience of parathyroid adenoma. Methods From November 1986 to August 2000, 9 patients with parathyroid adenoma who underwent operations were analyzed retrospectively. Out of them, there were 3 males and 6 females and their ages ranged from 12 to 55 years with an average of 32 years. The average disease course was 4 years and 9 months. General decreased density of the bone cortex and subperiosteum absorption were found in all 9 cases, while multi bone cyst lesion in 3 cases; obsolete fracture in 5 cases, including 2 cases of nephrolithiasis. Before operation, one child bore claudication and the other 8 patients suffered from disability. Serum parathyroid hormone (PTH) level increased markedly in 5 patients examined (633.87- 1 017.40 pmol/L, normal value: 28.50-90.50 pmol/L). Radionuclide scan showed that imagings of parathyroid adenoma appeared in 3 patients. Results Parathyroid adenoma was resected via neck approach in 7 cases, and by way of sternum in the other 2 of the adnomas located in the chest. Parathyroid adenoma was diagnosed pathologically in 9 cases. All the 9 patients had no relapse during the 2-16 years of follow-up, with apparent relief of ostealgia and the normal serum PTH level, and roentgenogram showed fracture healing, great alleviation of the osteopathia. Conclusion PTH examination as an advanced technique plays an important role in the differential diagnosis of hypercalcaemia. Color Doppler and radionuclide scan can locate the lesion. It is vital to judge the nature of the lesion by naked eyes, while frozen slices serves as a necessity to confirm. Enough parathyroid tissue should to be remained to assure normal parathyroid function. The variable number and ectopic possibility of parathyroid glands should be considered. Both the short-term and long-term surgical outcome of parathyroid adenoma are satisfactory.