摘要
目的：
探讨甲状旁腺肿瘤的临床特征、诊断、治疗方法及预后。
方法：
回顾性分析浙江大学医学院附属第二医院2000年1月至2010年3月收治并获随访的甲状旁腺肿瘤29例。
结果：
本研究组男14例,女15例,男女比例为1：1.1；年龄26—70岁,中位年龄为41岁。其中甲状旁腺腺瘤25例(86.2%),含两例多发,甲状旁腺癌4例(13.8%)。临床表现有泌尿系统症状11例次,骨及关节疼痛、四肢乏力10例次,颈部肿块9例次,腹痛3例次,呼吸及吞咽困难1例次,声音嘶哑1例次,胸闷心悸1例次。25例(86%)伴有甲状旁腺功能亢进表现,其中骨型14例(56%),肾型8例(32%),混合型3例(12%)。共有12例患者初诊为肾结石、骨折、甲状腺肿块等,误诊率41.4%(12／29)。术前定性检查为血清钙、血磷、碱性磷酸酶及甲状旁腺激素(PTH)检测；术前定位检查为B超、CT及99mTc甲氧基异丁基异腈闪烁放射计算机断层扫描(99mTc—MIBI)核素显像。全部病例均行手术治疗。25例甲状旁腺腺瘤,其中19例行单纯腺瘤切除术,6例合并同侧甲状腺次全或部分切除术。术后均获得症状缓解,但其中2例术后6月复发。4例甲状旁腺癌其中2例合并同侧甲状腺腺叶切除术,另2例还合并行颈部淋巴结清扫。随访结果示1例已无瘤生存3个月,2例分别于术后6个月、18个月复发,并于术后14个月、23个月死于顽固性高钙血症,1例失访。
结论：
甲状旁腺肿瘤临床表现多样。对于反复骨痛、肾结石伴有血钙升高的患者应警惕甲状旁腺疾病尤其是肿瘤的可能。通过常规检测血清钙和PTH可降低本病的误诊率。B超、CT及99mTc-MIBI等多种影像学检查可术前定位诊断。手术切除仍为甲状旁腺肿瘤的主要治疗手段。
Objective:To investigate the clinical features, diagnosis, treatment and prognosis of parathyroid neoplasm.
Method:We retrospectively analyzed 29 cases of parathyroid neoplasms, including the clinical symptoms and signs, laboratory, pathologic and imaging results for diagnosis and treatment in the second affiliated hospital of Zhejiang University from January,2000 to March,2010.
Results:The number of patients was 29, with males:females ratio being 1:1.1 and median age 41 years. There were 25 cases of parathyroid adenoma (86.2%),4 cases of parathyroid carcinoma (13.8%) in this study. The symptoms were as follows:11 cases of renal calculi,10 cases of skeleton pain and fatigue,9 cases of neck lump,3 cases of abdominal pain,1 case of dysphagia and dyspnoea,1 case of voice hoarseness,1 case of arrhythmia. Hyperparathyroidism was detected in 85% of them. Renal and skeletal involvement occurred in 56% and 32% respectively, while 12% of cases were mixed type. Serum calciumion and parathyroid hormone (PTH) levels were examined before operation. Ultrasonography, CT, MRI,99mTc—MIBI were used in locating parathyroid neoplasm before operation. All cases were treated with operation. Among 25 cases of parathyroid adenomas,19 cases received simple resections of tumors,5 plus thyroidectomy,1 plus partial resection of thyroid. All these patients achieved symptom remission. While 2 cases of them recurred 3,6 months after operation respectively. For 4 cases of parathyroid carcinomas, two were received radical resection (thyroid gland plus neck lymph node dissection), the others were simple parathyroidectomy. One patient survived 3 months without recurrence, while 2 cases recurred 6,18 months after operation respectively and died because of severe hypercalcemia after 14 and 23 months. Another patient lost follow-up.
Conclusion:A possible parathyroid tumor should be highly suspected when a patient had reiterative renal calculi and skeleton pain with hypercalcemia. Detecting the level of serum calcium and PTH together with image examination is useful to confirm diagnose of parathyroid tumor before operation. Surgery is still the best treatment for patient with parathyroid tumor.
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