专家讲座-武正炎-甲状旁腺机能亢进治疗

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1、•专家讲座・原发性甲状旁腺功能亢进症的外科治疗武正炎沈美萍陆辉210029江苏，南京医科人学第一附属医院江苏省人民医院普外科内分泌乳腺外科专业组【摘要】目的总结原发性卬状旁腺功能亢进症的诊断与治疗经验。方法回顾性分析1962年〜2007年7月我院手术治疗的84例原发性甲状旁腺功能亢进症的临床资料。结果联合B超、^Tc-MIBI核素扫描定位诊断率达到96.5%。双侧探杏甲状旁腺瘤切除12例，单侧探杏甲状旁腺席切除43例，颈部小切口甲状旁腺瘤切除19例。腺席78例，其小77例为单发腺瘤，甲状旁腺增生4例，甲状旁腺

2、癌1例，1例探查无明显病变。术后无严重并发症，2例持续甲状旁腺机能亢进，其余患者血钙降低或恢复止常，2例复发。手术治疗成功率95.2%。结论B超、"mTc-MIBin描是有效的术前定位检查手段；单侧甲状旁腺探查手术是有效的手术方法；颈部小切口甲状旁腺瘤切除对于定位诊断明确的患者有很好的应用前景。【关键词】原发性甲状旁腺功能亢进；手术治疗；双侧探查；单侧探查；颈部小切口。【中图分类号】R653ThesurgicaltreatmentofprimaryhyperparathyroidismWUZheng-yan9

3、SHENMei-pmg,LUHui.DivisionofEndocrineandBreastSurgery,DepartmentofGeneralSurgery,theFirstAffiliatedHospitalofNanjingMedicalUniversity,JiangsuProvinceHospital,Nanjing,210029[Abstract]ObjectivesTosummarizetheexperienceofdiagnosisandsurgicaltreatmentofprimaryh

4、yperparathyroidisminJiangsuProvinceHospital.Method84casesofprimaryhypeiparathyroidismdiagnosedandtreatedsurgicallyfrom1962through2007werestudiedretrospectively.Results84casesagedfrom11to73underwentoperationsforhypeiparathyroidismandwereidentifiedwithadenoma

5、in78cases,hyperplasiain4casesandcarcinomain1case・Allpatentsexcept4hadclinicalpresentation・30caseswerelocalizedpreoperativelybysestamibiscaningcombinedwithultrasonographysince1995and29showedpositiveresultsinbothexaminationasconfirmedbypathology.Bilateralexpl

6、orationswereperformedin12patientsand43caseswereexploredunilaterally,19casesunderwentminimallyinvasiveparathyroidectomythrougha3cmincision,4patientssufferedfromrecurrentorpersistenthyperparathyroidism.ConclusionsPreoperativelocalizationisveryhelpfulbysestami

7、biscaningcombinedwithultrasounography;Unilateralexplorationforparathyroidadenomaisfeasible;Minimallyinvasiveparathyroidectmythoughminimalincisionisakindofimprovingprocedureforthelocalizedparathyroidadenoma・[Keywords]primaryhyperparathyroidism(PHPT);surgical

8、treatment;bilateralexploration;unilateralexploration;Minimally;minimalcervicalincision原发性甲状旁腺功能亢进症(primaryhyperparathyroidism,PHPT)是因甲状旁腺腺瘤、增生或癌引起甲状旁腺索(PTH)H主性分泌过多而导致的以钙磷代谢紊乱、以骨和(或)肾病变为主耍临床特征的疾病。近年来，随着