Clinical Features and Factors for First Diagnosis of 100 Parathyroid Adenoma Patients
-
摘要:目的
探讨甲状旁腺腺瘤（parathyroid adenoma，PA）的首诊因素、临床表现、治疗和预后。
方法回顾性分析100例PA的临床资料。
结果100例PA的术前血钙（2.84±0.34）mmol/L；术前甲状旁腺素（PTH）中位数201 pg/ml。在首诊因素中，骨骼系统、泌尿系统症状的比例分别为17%、12%（P=0.000），血钙高、甲状旁腺占位的比例分别为32%、16%（P=0.000）。骨型、肾型、骨肾型分别为62%、43%、33%（P=0.000）。99Tcm-MIBI、B超、核磁、CT定位检查的阳性率分别为93.61%、82.52%、77.78%、74%（P=0.057）。19例双侧探查；23例单侧探查；58例未探查，术中均联合PTH监测。术后第1天PTH、血钙明显下降，血磷明显上升（P=0.000）。永久性的甲状旁腺功能减退5例。
结论血钙检测应列为常规筛查。骨痛、骨折、泌尿系结石、甲状旁腺占位应筛查PTH。99Tcm-MIBI作为定位诊断的首选。术中PTH监测可提高甲状旁腺瘤手术的成功率。
-
关键词:
- 原发性甲状旁腺功能亢进症 /
- 甲状旁腺腺瘤 /
- 临床表现 /
- 诊断因素
Abstract:ObjectiveTo analyze the factors for the first diagnosis, clinical features, treatment and prognosis of parathyroid adenoma(PA) patients.
MethodsWe reviewed the clinical date of 100 PA patients.
ResultsThe median preoperative parathyroid hormone(PTH) levels were 201pg/ml and serum calcium were (2.84±0.34) mmol/L in 100 PA patients. The first diagnoses due to the skeletal system and urinary system symptoms were observed in 17% and 12% of patients(P=0.000); those due to hypercalcemia and parathyroid placeholder found in physical examination were 32% and 16% of patients(P=0.000). The 100 cases were composed of 62% bone types, 43% kidney type, 33% skeletal and renal involvements(P=0.000). The localization positive rate of 99Tcm-MIBI scan, ultrasonography, MRI and CT were 93.61%, 82.52%, 77.78% and 74%(P=0.057). Nineteen cases with bilateral neck explorations, 23 cases with unilateral neck exploration and 58 cases with no exploration were performed. Intraoperative parathyroid hormone monitoring during parathyroidectomy for PA was used commonly. PTH, serum calcium on postoperative day 1 significantly decreased and blood phosphorus increased obviously(P=0.000), while five cases developed chronic hypoparathyroidism.
ConclusionBlood calcium screening should be routinely used. PTH screening for patients with bone pain, fracture, urinary calculi and parathyroid placeholder is recommended. 99Tcm-MIBI scan is preferred for the localization. Intraoperative parathyroid hormone monitoring during parathyroidectomy can improve the success rate of operation.
-
Key words:
- Primary hyperparathyroidism /
- Parathyroid adenoma /
- Clinical features /
- Diagnosis factor
-
-
表 1 100例PA患者首诊因素构成比
Table 1 Proportion of the first diagnosis factors of 100 patients with parathyroid adenoma(PA)
下载: 导出CSV
表 2 100例PA患者术前与术后第1天及第2天的血钙、血磷、PTH比较
Table 2 Comparison of blood calcium, blood phosphorus, parathyroid hormone of 100 PA patients before and day 1, day 2 after operation
下载: 导出CSV
-
[1] Eigelberger MS, Clark OH. Surgical approaches to primary hyperparathyroidism[J]. Endocrinol Metab Clin North Am, 2000, 29(3):479-502. doi: 10.1016/S0889-8529(05)70147-X
[2] AACE/AAES Task Force on Primary Hyperparathyroidism.The American of Clinical Endocrinologists and the American Association of Endocrine Surgeons position statement on the diagnosis and management of primary hyperparathyroidism[J].Endocr Pract, 2005, 11(1):49-54. doi: 10.4158/EP.11.1.49
[3] 邢小平, 王鸥, 孟迅吾, 等.北京与纽约原发性甲状旁腺功能亢进症临床表现的比较[J].诊断学理论与实践, 2006, 5(6):483-6. http://www.cnki.com.cn/Article/CJFDTOTAL-ZDLS200606008.htm Xing XP, Wang O, Meng XW, et al. Comparison of clinical manifestations in patients with primary hyperparathyroidism between districts of Beijing and New York[J]. Zhen Duan Xue Li Lun Yu Shi Jian, 2006, 5(6):483-6. http://www.cnki.com.cn/Article/CJFDTOTAL-ZDLS200606008.htm
[4] 董建宇, 管珩, 朱预.甲状旁腺功能亢进症455例临床症状分析[J].中国医学科学院学报, 2011, 33(3):330-3. http://www.cnki.com.cn/Article/CJFDTOTAL-ZYKX201103022.htm Dong JY, Guang H, Zhu Y. Clinical symptoms in 455 hyperparathyroidism patients[J]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao, 2011, 33(3):330-3. http://www.cnki.com.cn/Article/CJFDTOTAL-ZYKX201103022.htm
[5] 左庆瑶, 刘宝岳, 邓丽丽.原发性甲状旁腺功能亢进症85例临床及病理分析[J].重庆医学, 2012, 41(20):2027-31. http://www.cnki.com.cn/Article/CJFDTOTAL-CQYX201220010.htm Zuo QY, Liu BY, Deng LL. Clinical and pathological analysis of primary hyperthyroidism in 85 cases[J]. Chongqing Yi Xue, 2012, 41(20):2027-31. http://www.cnki.com.cn/Article/CJFDTOTAL-CQYX201220010.htm
[6] 朱信心, 魏涛, 龚日祥, 等. 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):452-7. doi: 10.7507/1007-9424.20140110 Zhu XX, Wei T, Gong RX. Experience of diagnosis and treatment of 136 patients with primary hyperparathyroidism[J]. Zhongguo Pu Wai Ji Chu Yu Lin Chuang Za Zhi, 2014, 21(4):452-7. doi: 10.7507/1007-9424.20140110
[7] 王丽娟, 袁鹰.原发性甲状旁腺功能亢进症44例临床分析[J].青岛大学医学院学报, 2016, 52(1):83-8. http://www.cnki.com.cn/Article/CJFDTOTAL-BATE201601029.htm Wang LJ, Yuan Y. Primary hyperparathyroidism:clinical analysis of 44 cases[J]. Qingdao Da Xue Yi Xue Yuan Xue Bao, 2016, 52(1):83-8. http://www.cnki.com.cn/Article/CJFDTOTAL-BATE201601029.htm
[8] Zhao L, Liu JM, He XY, et al. The changing clinical patterns of primary hyperparathyroidism in Chinese patients:data from 2000 to 2010 in single clinical center[J]. J Clin Endocrinol Metab, 2013, 98(2):721-8. doi: 10.1210/jc.2012-2914
[9] 魏伯俊.原发性甲状旁腺功能亢进的诊治[J].山东大学耳鼻喉眼学报, 2016, 30(2):32-5. doi: 10.6040/j.issn.1673-3770.1.2016.09 Wei BJ. Diagnosis and surgical treatment of primary hyperpara-thyroidism[J]. Shandong Da Xue Er Bu Hou Yan Xue Bao, 2016, 30(2):32-5. doi: 10.6040/j.issn.1673-3770.1.2016.09
[10] Silverberg SJ, Walker MD, Bilezikian JP. Asymptomatic primary hyperparathyroidism[J]. J Clin Densitom, 2013, 16(1):14-21. doi: 10.1016/j.jocd.2012.11.005
[11] Sklavenitis-Pistofidis R, Papaioannou O, Kotsa K. Primary hyperparathyroidism and the road to surgery:appraisal of the proceedings of the four international workshops (1990, 2002, 2008, 2014) on primary hyperparathyroidism[J]. Hormones (Athens), 2015, 14(2):201-10.
[12] Rao DS, Honasoge M, Divine GW, et al. Effect vitamin D nutrition on parathyroid adenoma weight:pathogenetic and clinical implications[J]. J Clin Endocrinol Metab, 2000, 85(3):1054-8.
[13] Bilezikian JP, Silverberg SJ. Normocalcemic primary hyperparathyroidism[J]. Arq Bras Endocrinol Metabol, 2010, 54(2):106-9. doi: 10.1590/S0004-27302010000200004
[14] Walker MD, Rubin M, Silverberg SJ. Nontraditional manifestations of primary hyperparathyroidism[J]. J Clin Densitom, 2013, 16(1):40-7. doi: 10.1016/j.jocd.2012.11.008
[15] 隋建, 于愿, 薛新波, 等.原发性甲状旁腺功能亢进症73例诊断分析[J].实用医学杂志, 2010, 26(15):2791-3. doi: 10.3969/j.issn.1006-5725.2010.15.044 Sui J, Yu Y, Xue XP, et al. Diagnosis and analysis of 73 cases of primary hyperthyroidism[J]. Shi Yong Yi Xue Za Zhi, 2010, 26(15):2791-3. doi: 10.3969/j.issn.1006-5725.2010.15.044
[16] 杨志强, 朱理玮, 王鹏志. 48例甲状旁腺腺瘤和腺癌的临床分析[J].中华肿瘤杂志, 2006, 28(8):625-7. http://youxian.cnki.com.cn/yxdetail.aspx?filename=ZLFY20171027007&dbname=CAPJ2015 Yang ZQ, Zhu LW, Wang PZ. Diagnosis and surgical treatment of parathyroid adenoma and parathyroid carcinoma[J]. Zhonghua Zhong Liu Za Zhi, 2006, 28(8):625-7. http://youxian.cnki.com.cn/yxdetail.aspx?filename=ZLFY20171027007&dbname=CAPJ2015
[17] 贺晓燕, 韩晴, 陈曦, 等. 160例原发性甲状旁腺功能亢进症患者临床资料初步分析[J].诊断学理论与实践, 2007, 6(3):243-7. http://www.cnki.com.cn/Article/CJFDTOTAL-ZDLS200703017.htm He XY, Han Q, Chen X, et al. Preliminary analysis of clinical presentations of 160 cases primary hyperparathyroidism[J]. Zhen Duan Xue Li Lun Yu Shi Jian, 2007, 6(3):243-7. http://www.cnki.com.cn/Article/CJFDTOTAL-ZDLS200703017.htm
[18] McCoy KL, Chen NH, Armstrong MJ, et al. The small abnormal parathyroid gland is increasingly common and heralds operative complexity[J].World J Surg, 2014, 38(6):1274-81. doi: 10.1007/s00268-014-2450-1
[19] Abdulla AG, Ituarte PH, Harari A, et al. Trends in the frequency and quality of parathyroid surgery:analysis of 17, 082 cases over 10 years[J]. Ann Surg, 2015, 261(4):746-50. doi: 10.1097/SLA.0000000000000812
[20] Allendorf J, DiGorgi M, Spanknebel K, et al. 1112 consecutive bilateral neck explorations for primary hyperparathyroidism[J].World J Surg, 2007, 31(11):2075-80. doi: 10.1007/s00268-007-9068-5
计量
- 文章访问数: 2243
- HTML全文浏览量: 609
- PDF下载量: 640
