原发性甲状旁腺功能亢进伴发分化型甲状腺癌的外科诊疗进展
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摘要
原发性甲状旁腺功能亢进时体内存在病变的甲状旁腺,首选外科手术治疗,通常甲状旁腺功能亢进的患者可经手术治疗达到治愈;分化型甲状腺癌在甲状腺癌中占主要部分,需及时发现并手术治疗,预后较好。原发性甲状旁腺功能亢进时存在伴发分化型甲状腺癌的风险,处理甲状旁腺疾病而忽略甲状腺癌时患者常需要二次手术,被忽略的甲状腺癌及二次手术对患者生理及心理存在一定影响。考虑此类疾病风险的存在,应在术前对患者进行充分评估并诊断此类疾病,合理选择手术方式。
There are pathological parathyroid glands in the body when a patient gets primary hyperparathyroidism,for whom surgical treatment is the first choiceto achieve cure in most cases; differentiated thyroid cancer is the main type of thyroid cancer and it needs timely detection and surgical treatment,which has good prognosis. According to the research,there is a risk of differentiated thyroid cancer associated with primary hyperparathyroidism. When dealing with parathyroid diseases and neglecting thyroid cancer,a secondary surgery is often needed,which has certain effects on the physiology and psychology of the patients. Considering the risk of this kind of disease,the patients should be fully evaluated and diagnosed before operation,to choose the surgical methods reasonably.
There are pathological parathyroid glands in the body when a patient gets primary hyperparathyroidism,for whom surgical treatment is the first choiceto achieve cure in most cases; differentiated thyroid cancer is the main type of thyroid cancer and it needs timely detection and surgical treatment,which has good prognosis. According to the research,there is a risk of differentiated thyroid cancer associated with primary hyperparathyroidism. When dealing with parathyroid diseases and neglecting thyroid cancer,a secondary surgery is often needed,which has certain effects on the physiology and psychology of the patients. Considering the risk of this kind of disease,the patients should be fully evaluated and diagnosed before operation,to choose the surgical methods reasonably.
引文
[1]中华医学会骨质疏松和骨矿盐疾病分会.原发性甲状旁腺功能亢进症诊疗指南[J].中华骨质疏松和骨矿盐疾病杂志,2014,7(3):187-198.
[2]田文,姚京.原发性甲状旁腺功能亢进的外科治疗及评价[J].中国实用外科杂志,2014,34(4):303-305.
[3]田雨霖.原发性甲状旁腺功能亢进症的诊断与外科治疗[J].中国实用外科杂志,2008,43(3):221-223.
[4]朱信心,魏涛,龚日祥.136例原发性甲状旁腺功能亢进的诊治体会[J].中国普外基础与临床杂志,2014,21(4):452-457.
[5]郑向前,候秀坤,高明.2017年第二版NCCN甲状腺肿瘤指南解读[J].中国肿瘤临床,2018,45(1):14-17.
[6]胡亚,廖泉,牛哲禹,等.甲状旁腺功能亢进合并分化型甲状腺癌384例诊治分析[J].中国实用外科杂志,2014,34(4):329-331.
[7]苏磊,王雪晨,姚永忠,等.原发性甲状旁腺功能亢进症合并甲状腺疾病的诊治体会[J].中国普外基础与临床杂志,2010,17(12):1290-1293.
[8]Yazici P,Mihmanli M,Bozdag E,et al.Incidental Finding of Papillary Thyroid Carcinoma in the Patients with Primary Hyperparathyroidism[J].Eurasian J Med,2015,47(3):194-198.
[9]陈海珍,薛松,陈曦.甲状旁腺癌的诊断和治疗(附30例报告)[J].中国实用外科杂志,2014,34(4):324-328.
[10]李晓曦.实验室检查在甲状腺结节诊治中的合理选择与评价[J].中国实用外科杂志,2015,35(6):629-633.
[11]王莹,张新杰,李乐晨.慢性炎症与甲状腺癌关系的研究进展[J].现代生物医学进展,2013,13(25):4999-5000,4971.
[12]宋坤,陈杭美,王华.CT对甲状旁腺腺瘤的诊断及其应用价值[J].放射学实践,2012,27(1):105-106.
[13]谭军,阎东,孙勇.MRI对甲状旁腺腺瘤的诊断价值[J].实用医学影像杂志,2008,9(1):13-15.
[14]陈富星,肖维华,胡燕标.甲状腺结节105例多层螺旋CT表现与病理对照分析[J].中国临床医学影像杂志,2014,25(10):696-699.
[15]张煜,张卧,丁金旺.甲状腺内异位甲状旁腺及腺瘤诊治分析[J].中华全科医学,2015,13(8):1374-1375,1385.
[16]董屹婕,詹维伟.超声引导下细针穿刺在甲状腺结节诊断和鉴别诊断中的价值[J].中国实用外科杂志,2015,35(6):613-619.
[17]Mizamtsidi M,Nastos C,Mastorakos G,et al.Diagnosis,management,histology and genetics of sporadic primary hyperparathyroidism:Old knowledge with new tricks[J].Endocr Connect,2018,7(2):R56-68.
[18]Yabuta T,Tsushima Y,Masuoka H,et al.Ultrasonographic features of intrathyroidal parathyroid adenoma causing primary hyperparathyroidism[J].Endocr J,2011,58(11):989-994.
[19]侯英萍,邓敬兰,乔宏庆.甲状旁腺腺瘤和增生的99Tcm-MIBI甲状旁腺显像特点及其临床价值[J].中国临床医学影像杂志,2002,13(1):6-9.
[20]赵长久.核医学在甲状旁腺疾病诊疗中的应用[J].临床外科杂志,2018,26(6):413-415.
[21]黎俊,李莉,林华.99mTc-MIBI双时相显像与SPECT/CT融合显像对原发性甲状旁腺功能亢进症的诊断价值[J].医学影像学杂志,2017,27(6):1063-1067.
[22]Khan AA,Hanley DA,Rizzoli R,et al.Primary hyperparathyroidism:Review and recommendations on evaluation,diagnosis,and management.A Canadian and international consensus[J].Osteoporos Int,2017,28(1):1-19.
[23]田文,姚京.甲状腺全切除术在甲状腺癌外科治疗中的价值及合理选择[J].中国实用外科杂志,2014,34(1):52-54,58.
[24]田文,罗晋.中国与美国甲状腺结节与分化型甲状腺癌诊治指南比较[J].中国实用外科杂志,2013,33(6):475-479.
[25]高明.甲状腺结节和分化型甲状腺癌诊治指南[J].中国肿瘤临床,2012,39(17):1249-1272.
[26]张平,王志宏,贺亮.甲状旁腺癌的外科诊断与治疗[J].现代肿瘤医学,2014,22(3):542-545.
[27]胡亚,廖泉,曹少博.原发性甲状旁腺功能亢进术后低钙血症相关因素分析[J].中国实用外科杂志,2016,36(1):119-121.
[28]吴兆书,斯岩,金臻.甲状旁腺功能亢进症术后PTH变化规律及其临床意义[J].南京医科大学学报(自然科学版),2015,35(6):849-853.
[29]中国抗癌协会头颈肿瘤专业委员会.分化型甲状腺癌诊治指南[J].中国实用外科杂志,2011,31(10):908-914.
[30]高成业,翟菊敏,董谦.小切口直接甲状旁腺腺瘤切除术治疗原发性甲状旁腺功能亢进18例报道[J].中国普外基础与临床杂志,2015,22(9):1124-1126.
[31]周建平,张浩,董明.原发性甲状旁腺功能亢进症手术方式的选择[J].中国普通外科杂志,2008,17(11):1121-1123.
[2]田文,姚京.原发性甲状旁腺功能亢进的外科治疗及评价[J].中国实用外科杂志,2014,34(4):303-305.
[3]田雨霖.原发性甲状旁腺功能亢进症的诊断与外科治疗[J].中国实用外科杂志,2008,43(3):221-223.
[4]朱信心,魏涛,龚日祥.136例原发性甲状旁腺功能亢进的诊治体会[J].中国普外基础与临床杂志,2014,21(4):452-457.
[5]郑向前,候秀坤,高明.2017年第二版NCCN甲状腺肿瘤指南解读[J].中国肿瘤临床,2018,45(1):14-17.
[6]胡亚,廖泉,牛哲禹,等.甲状旁腺功能亢进合并分化型甲状腺癌384例诊治分析[J].中国实用外科杂志,2014,34(4):329-331.
[7]苏磊,王雪晨,姚永忠,等.原发性甲状旁腺功能亢进症合并甲状腺疾病的诊治体会[J].中国普外基础与临床杂志,2010,17(12):1290-1293.
[8]Yazici P,Mihmanli M,Bozdag E,et al.Incidental Finding of Papillary Thyroid Carcinoma in the Patients with Primary Hyperparathyroidism[J].Eurasian J Med,2015,47(3):194-198.
[9]陈海珍,薛松,陈曦.甲状旁腺癌的诊断和治疗(附30例报告)[J].中国实用外科杂志,2014,34(4):324-328.
[10]李晓曦.实验室检查在甲状腺结节诊治中的合理选择与评价[J].中国实用外科杂志,2015,35(6):629-633.
[11]王莹,张新杰,李乐晨.慢性炎症与甲状腺癌关系的研究进展[J].现代生物医学进展,2013,13(25):4999-5000,4971.
[12]宋坤,陈杭美,王华.CT对甲状旁腺腺瘤的诊断及其应用价值[J].放射学实践,2012,27(1):105-106.
[13]谭军,阎东,孙勇.MRI对甲状旁腺腺瘤的诊断价值[J].实用医学影像杂志,2008,9(1):13-15.
[14]陈富星,肖维华,胡燕标.甲状腺结节105例多层螺旋CT表现与病理对照分析[J].中国临床医学影像杂志,2014,25(10):696-699.
[15]张煜,张卧,丁金旺.甲状腺内异位甲状旁腺及腺瘤诊治分析[J].中华全科医学,2015,13(8):1374-1375,1385.
[16]董屹婕,詹维伟.超声引导下细针穿刺在甲状腺结节诊断和鉴别诊断中的价值[J].中国实用外科杂志,2015,35(6):613-619.
[17]Mizamtsidi M,Nastos C,Mastorakos G,et al.Diagnosis,management,histology and genetics of sporadic primary hyperparathyroidism:Old knowledge with new tricks[J].Endocr Connect,2018,7(2):R56-68.
[18]Yabuta T,Tsushima Y,Masuoka H,et al.Ultrasonographic features of intrathyroidal parathyroid adenoma causing primary hyperparathyroidism[J].Endocr J,2011,58(11):989-994.
[19]侯英萍,邓敬兰,乔宏庆.甲状旁腺腺瘤和增生的99Tcm-MIBI甲状旁腺显像特点及其临床价值[J].中国临床医学影像杂志,2002,13(1):6-9.
[20]赵长久.核医学在甲状旁腺疾病诊疗中的应用[J].临床外科杂志,2018,26(6):413-415.
[21]黎俊,李莉,林华.99mTc-MIBI双时相显像与SPECT/CT融合显像对原发性甲状旁腺功能亢进症的诊断价值[J].医学影像学杂志,2017,27(6):1063-1067.
[22]Khan AA,Hanley DA,Rizzoli R,et al.Primary hyperparathyroidism:Review and recommendations on evaluation,diagnosis,and management.A Canadian and international consensus[J].Osteoporos Int,2017,28(1):1-19.
[23]田文,姚京.甲状腺全切除术在甲状腺癌外科治疗中的价值及合理选择[J].中国实用外科杂志,2014,34(1):52-54,58.
[24]田文,罗晋.中国与美国甲状腺结节与分化型甲状腺癌诊治指南比较[J].中国实用外科杂志,2013,33(6):475-479.
[25]高明.甲状腺结节和分化型甲状腺癌诊治指南[J].中国肿瘤临床,2012,39(17):1249-1272.
[26]张平,王志宏,贺亮.甲状旁腺癌的外科诊断与治疗[J].现代肿瘤医学,2014,22(3):542-545.
[27]胡亚,廖泉,曹少博.原发性甲状旁腺功能亢进术后低钙血症相关因素分析[J].中国实用外科杂志,2016,36(1):119-121.
[28]吴兆书,斯岩,金臻.甲状旁腺功能亢进症术后PTH变化规律及其临床意义[J].南京医科大学学报(自然科学版),2015,35(6):849-853.
[29]中国抗癌协会头颈肿瘤专业委员会.分化型甲状腺癌诊治指南[J].中国实用外科杂志,2011,31(10):908-914.
[30]高成业,翟菊敏,董谦.小切口直接甲状旁腺腺瘤切除术治疗原发性甲状旁腺功能亢进18例报道[J].中国普外基础与临床杂志,2015,22(9):1124-1126.
[31]周建平,张浩,董明.原发性甲状旁腺功能亢进症手术方式的选择[J].中国普通外科杂志,2008,17(11):1121-1123.