中国普外基础与临床杂志

中国普外基础与临床杂志

意外甲状旁腺腺瘤的临床特点分析及诊疗体会

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目的 总结意外甲状旁腺腺瘤(APTA)的临床特点并探讨其诊疗方法。 方法 纳入 2009 年 2 月至 2016 年 12 月期间于四川大学华西医院甲状(旁)腺疾病诊疗中心入院拟行甲状腺手术时术前检查意外发现无症状甲状旁腺腺瘤的患者作为研究对象,对 APTA 发现率、临床特点、手术方式及术后随访结果做分析;并将其与同期单纯性原发性甲状旁腺腺瘤患者的临床资料进行比较,同时将其与按 1∶4 比例随机选取同期非 APTA 单纯行甲状腺手术的患者进行对比分析。 结果 共收治行甲状腺手术患者 5 881 例,同期共收治单纯性原发性甲状旁腺腺瘤患者 251 例。结果发现 APTA 患者 26 例,APTA 的发现率为 0.44%(26/5 881),占同期手术治疗的单纯性原发性甲状旁腺腺瘤的 10.4%(26/251)。术前行超声定位阳性率为 69.2%(18/26),行甲状旁腺核素显像阳性率为 72.7%(8/11),行骨密度检查异常率为 85.7%(6/7)。术前检查 APTA 患者的甲状旁腺素(PTH)为(38.17±40.69)pmol/L(3.40~181.20 pmol/L),血钙为(2.73±0.27)mmol/L(2.22~3.23 mmol/L)。26 例 APTA 患者中单发 23 例(88.5%),多发 3 例(11.5%),腺瘤个数共 31 个;病灶直径为(21.72±9.65)mm;甲状旁腺右下占 55.2%(16/29),右上占 6.9%(2/29),左下占 27.6%(8/29),左上占 10.3%(3/29);分型为 A1 型占 44.8%(13/29),B1 型占 55.2%(16/29)。术后复发 2 例(7.7%),术后暂时性甲状旁腺功能减退 8 例(30.8%),永久性甲状旁腺功能减退 1 例(3.8%)。APTA 患者术前 PTH 和血钙水平均明显低于同期单纯性原发性甲状旁腺腺瘤患者(P<0.001、P<0.001),但其明显高于同期非 APTA 单纯行甲状腺手术患者(P=0.001,P<0.001)。 结论 APTA 为无症状原发性甲状旁腺功能亢进的一种特殊类型。甲状腺手术前常规行 PTH 和血钙检查对发现 APTA 至关重要。对于 APTA 患者,在行甲状腺相关手术的同时行甲状旁腺腺瘤探查切除术安全、有效,预后良好。

Objective To investigate clinical features of accidental parathyroid adenoma (APTA) and to explore diagnosis and treatment strategies of APTA. Methods From February 2009 to December 2016, the patients who would receive the thyroid surgery and were accidentally found the parathyroid adenoma by preoperative examination in the Department of Thyroid & Parathyroid Surgery, West China Hospital of Sichuan University were enrolled in the research. The clinical characteristics, surgical procedure, results of postoperative follow-up were analyzed retrospectively, and which were compared between the patients with APTA and the other patients diagnosed as primary parathyroid adenoma or received thyroid surgery (1 : 4 chosen randomly) in the same period. Results From February 2009 to December 2016, the patients who treated with thyroid surgery and were diagnosed as the primary parathyroid adenoma in our center were 5 881 and 251 respectively. Twenty-six patients with APTA were found in this research. The incidence rate of APTA was 0.44% (26/5 881), accounted for 10.4% (26/251) of the primary parathyroid adenoma. The positive rates of the ultrasound and the parathyroid scintigraphy were 69.2% (18/26) and 72.7% (8/11), respectively. The abnormal rate of the bone mineral density examination was 85.7% (6/7). The preoperative PTH was (38.17±40.69) pmol/L (3.40–181.20 pmol/L), and the serum calcium was (2.73±0.27) mmol/L (2.22–3.23 mmol/L). The number of detected parathyroid adenoma was 29, which were 55.2% (16/29) in the right-lower, 6.9% (2/29) in the right-upper, 27.6% (8/29) in the left-lower, and 10.3% (3/29) in the left-upper location. The rate of single parathyroid adenoma was 88.5% (23/26) and the maximum diameter of parathyroid adenoma was (21.72±9.65) mm. There was 13 cases (44.8%) of the A1 type and 16 cases (55.2%) of the B1 type in these 29 parathyroid adenomas. The rates of the recurrence, postoperative transient hypoparathyroidism, and permanent hypoparathyroidism were 7.7% (2/26), 30.8% (8/26), and 3.8% (1/26), respectively. Additionally, the preoperative PTH and serum calcium levels of the patients with APTA were significantly lower as compared with the primary parathyroid adenoma (P<0.001,P<0.001), which were significantly higher as compared with those of the patients received thyroid surgery without APTA in the same period (P=0.001, P<0.001). Conclusions APTA is a specific type of asymptomatic primary hyperparathyroidism. Examinations for PTH and serum calcium levels before thyroid surgery are important for finding APTA. For the patients with APTA, it is safe and effective to carry out exploratory parathyroidectomy with thyroid surgery at the same time.

关键词: 意外甲状旁腺腺瘤; 术前检查; 甲状腺手术; 手术治疗

Key words: accidental parathyroid adenoma; preoperative examination; thyroid surgery; surgical strategy

引用本文: 赵婉君, 苏安平, 罗晗, 魏涛, 李志辉, 龚日祥, 朱精强. 意外甲状旁腺腺瘤的临床特点分析及诊疗体会. 中国普外基础与临床杂志, 2018, 25(4): 416-423. doi: 10.7507/1007-9424.201709067 复制

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