专家讲座-武正炎-甲状旁腺机能亢进治疗.docVIP

·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，南京医科大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 总结原发性甲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、99mTc-MIBI核素扫描定位诊断率达到96.5%。双侧探查甲状旁腺瘤切除12例，单侧探查甲状旁腺瘤切除43例，颈部小切口甲状旁腺瘤切除19例。腺瘤78例，其中77例为单发腺瘤，甲状旁腺增生4例，甲状旁腺癌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正常，2例复发。手术治疗成功率95.2%。结论 B超、99mTc-MIBI扫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R653 The surgical treatment of primary hyperparathyroidism WU Zheng-yan,SHEN Mei-ping, LU Hui .Division of Endocrine and Breast Surgery, Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029 【Abstract】Objectives To summarize the experience of diagnosis and surgical treatment of primary hyperparathyroidism in Jiangsu Province Hospital. Method 84 cases of primary hyperparathyroidism diagnosed and treated surgically from 1962 through 2007 were studied retrospectively. Results 84 cases aged from 11 to 73 underwent operations for hyperparathy roidism and were identified with adenoma in 78 cases, hyperplasia in 4 cases and carcinoma in 1 case. All patents except 4 had clinical presentation. 30 cases were localized preoperatively by sestamibi scaning combined with ultrasonography since 1995 and 29 showed positive results in both examination as confirmed by pathology. Bilateral explorations were performed in 12 patients and 43 cases were explored unilaterally, 19 cases underwent minimally invasive parathyroidectomy through a 3cm incision, 4 patients suffered from recurrent or persistent hyperparathyroidism.Conclusions Preoperative localization is very helpful by sestamibi scaning combined with ultrasounography; Unilateral exploration for parathyroid adenoma is feasible; Minimally invasive parathyroidectmy though minimal incision is a kind of improving procedure for the localized parathyroid adenoma. 【Key words】 prim