目的 探討原發(fā)性甲狀旁腺功能亢進癥同時合并甲狀腺疾病的臨床診斷和治療方法。方法 對40例原發(fā)性甲狀旁腺功能亢進癥同時合并甲狀腺疾病患者的臨床表現(xiàn),術(shù)前定性、定位診斷及手術(shù)治療方法與結(jié)果的資料進行回顧性分析。結(jié)果 40例患者中甲狀旁腺腺瘤合并甲狀腺乳頭狀癌4例，合并結(jié)節(jié)性甲狀腺腫28例，合并甲狀腺腺瘤6例； 甲狀旁腺增生合并結(jié)節(jié)性甲狀腺腫1例； 甲狀旁腺癌合并甲狀腺腺瘤1例。對于40例甲狀旁腺及甲狀腺病變定位診斷敏感性B超、CT和放射性核素顯像（99Tcm顯像）分別為82.5%(33/40)、80.0%(32/40)和90.0%(36/40)，而三者結(jié)合可使定位診斷敏感性達97.5%(39/40)。手術(shù)方式： 甲狀旁腺腺瘤切除并甲狀腺腺葉次全切除34例，甲狀旁腺腺瘤切除并甲狀腺全葉切除3例，雙側(cè)甲狀旁腺探查并甲狀腺腺葉次全切除1例，一側(cè)甲狀旁腺切除并甲狀腺腺葉切除及頸淋巴結(jié)清掃2例。結(jié)論 B超、CT和核素顯像三者結(jié)合可使原發(fā)性甲狀旁腺功能亢進癥合并甲狀腺疾病的術(shù)前定位診斷敏感性明顯提高，手術(shù)切除是主要的治療手段，主要術(shù)式為甲狀旁腺腺瘤切除并甲狀腺腺葉次全或全葉切除。
引用本文： 蘇磊,王雪晨,姚永忠,桑劍鋒. 原發(fā)性甲狀旁腺功能亢進癥合并甲狀腺疾病的診治體會. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(12): 1290-1293. doi: 復制
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| 2. | Moka D, Voth E, Dietlein M, et al. Technetium 99m-MIBI-SPECT: A highly sensitive diagnostic tool for localization of parathyroid adenomas [J]. Surgery, 2000; 128(1): 29-35. |
| 3. | 周建平, 李昱驥, 董明芳. 原發(fā)性甲狀旁腺功能亢進的定位診斷 [J]. 中華普通外科雜志, 2005; 20(4): 227-228. |
| 4. | 王旭東, 吳延升, 張文超. 42例甲狀旁腺腫瘤的診斷及外科治療分析 [J]. 中國腫瘤臨床, 2007; 34(11): 636-639. |
| 5. | 解乃昌, 林進令, 陸云飛. 18例原發(fā)性甲狀旁腺功能亢進癥的診治分析 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(1): 87-88. |
| 6. | Saint Marc O, Cogliandolo A, Pidoto RR, et al. Prospective evaluation of ultrasonography plus MIBI scintigraphy in selecting patients with primary hyperparathyroidism for unilateral neck exploration under local anaesthesia [J]. Am J Surg, 2004; 187(3): 388-393. |
| 7. | 王茜, 高伯山, 秦淑玲. MRI及99Tcm-MIBI顯像對甲狀旁腺機能亢進癥的診斷價值 [J]. 中華核醫(yī)學雜志, 2002; 22(1): 28-30. |
| 8. | 田雨霖. 原發(fā)性甲狀旁腺功能亢進癥的診斷與外科治療 [J]. 中國實用外科雜志, 2008; 28(3): 221-223. |
| 9. | Chen H, Pruhs Z, Starling JR, et al. Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy [J]. Surgery, 2005; 138(4): 583-587. |
| 10. | 陳瑞新, 鄭澤霖. 內(nèi)鏡下甲狀腺、甲狀旁腺切除手術(shù) [J]. 中國普外基礎(chǔ)與臨床雜志, 2001; 8(5): 353-354. |
| 11. | Baliski CR, Stewart JK, Anderson DW, et al. Selective unilateral parathyroid exploration: an effective treatment for primary hyperparathyroidism [J]. Am J Surg, 2005; 189(5): 596-600. |
| 12. | Bergenfelz A, Kanngiesser V, Zielke A, et al. Conventional bilateral cervical exploration versus open minimally invasive parathyroidectomy under local anaesthesia for primary hyperparathyroidism [J]. Br J Surg, 2005; 92(2): 190-197. |
| 13. | Riss P, Kaczirek K, Heinz G, et al. A “defined baseline” in PTH monitoring increases surgical success in patients with multiple gland disease [J]. Surgery, 2007; 142(3): 398-404. |
| 14. | Goldstein RE, Carter WM 2nd, Fleming M, et al. Unilateral cervical surgical exploration aided by intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism and equivocal sestamibi scan results [J]. Arch Surg, 2006; 141(6): 552-557. |
| 15. | 楊志強, 朱理瑋, 王鵬志. 48例甲狀旁腺腺瘤和腺癌的臨床分析 [J]. 中華腫瘤雜志, 2006; 28(8): 625-627. |
| 16. | Inabnet WB. Intraoperative parathyroid hormone monitoring [J]. World J Surg, 2004; 28(12): 1212-1215. |
| 17. | 朱預(yù). 原發(fā)性甲狀旁腺功能亢進癥的治療 [J]. 中國普外基礎(chǔ)與臨床雜志, 2004; 11(6): 477-478. |
| 18. | Hundahl SA, Fleming ID, Fremgen AM, et al. Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985-1995: a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society [J]. Cancer, 1999; 86(3): 538-544. |
- 1. 李志輝, 朱精強, 魏濤, 等. 甲狀旁腺在人體中的分布特點及臨床意義(附50 例解剖研究報告) [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(5): 311-313, 317.
- 2. Moka D, Voth E, Dietlein M, et al. Technetium 99m-MIBI-SPECT: A highly sensitive diagnostic tool for localization of parathyroid adenomas [J]. Surgery, 2000; 128(1): 29-35.
- 3. 周建平, 李昱驥, 董明芳. 原發(fā)性甲狀旁腺功能亢進的定位診斷 [J]. 中華普通外科雜志, 2005; 20(4): 227-228.
- 4. 王旭東, 吳延升, 張文超. 42例甲狀旁腺腫瘤的診斷及外科治療分析 [J]. 中國腫瘤臨床, 2007; 34(11): 636-639.
- 5. 解乃昌, 林進令, 陸云飛. 18例原發(fā)性甲狀旁腺功能亢進癥的診治分析 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(1): 87-88.
- 6. Saint Marc O, Cogliandolo A, Pidoto RR, et al. Prospective evaluation of ultrasonography plus MIBI scintigraphy in selecting patients with primary hyperparathyroidism for unilateral neck exploration under local anaesthesia [J]. Am J Surg, 2004; 187(3): 388-393.
- 7. 王茜, 高伯山, 秦淑玲. MRI及99Tcm-MIBI顯像對甲狀旁腺機能亢進癥的診斷價值 [J]. 中華核醫(yī)學雜志, 2002; 22(1): 28-30.
- 8. 田雨霖. 原發(fā)性甲狀旁腺功能亢進癥的診斷與外科治療 [J]. 中國實用外科雜志, 2008; 28(3): 221-223.
- 9. Chen H, Pruhs Z, Starling JR, et al. Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy [J]. Surgery, 2005; 138(4): 583-587.
- 10. 陳瑞新, 鄭澤霖. 內(nèi)鏡下甲狀腺、甲狀旁腺切除手術(shù) [J]. 中國普外基礎(chǔ)與臨床雜志, 2001; 8(5): 353-354.
- 11. Baliski CR, Stewart JK, Anderson DW, et al. Selective unilateral parathyroid exploration: an effective treatment for primary hyperparathyroidism [J]. Am J Surg, 2005; 189(5): 596-600.
- 12. Bergenfelz A, Kanngiesser V, Zielke A, et al. Conventional bilateral cervical exploration versus open minimally invasive parathyroidectomy under local anaesthesia for primary hyperparathyroidism [J]. Br J Surg, 2005; 92(2): 190-197.
- 13. Riss P, Kaczirek K, Heinz G, et al. A “defined baseline” in PTH monitoring increases surgical success in patients with multiple gland disease [J]. Surgery, 2007; 142(3): 398-404.
- 14. Goldstein RE, Carter WM 2nd, Fleming M, et al. Unilateral cervical surgical exploration aided by intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism and equivocal sestamibi scan results [J]. Arch Surg, 2006; 141(6): 552-557.
- 15. 楊志強, 朱理瑋, 王鵬志. 48例甲狀旁腺腺瘤和腺癌的臨床分析 [J]. 中華腫瘤雜志, 2006; 28(8): 625-627.
- 16. Inabnet WB. Intraoperative parathyroid hormone monitoring [J]. World J Surg, 2004; 28(12): 1212-1215.
- 17. 朱預(yù). 原發(fā)性甲狀旁腺功能亢進癥的治療 [J]. 中國普外基礎(chǔ)與臨床雜志, 2004; 11(6): 477-478.
- 18. Hundahl SA, Fleming ID, Fremgen AM, et al. Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985-1995: a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society [J]. Cancer, 1999; 86(3): 538-544.