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1、·專家講座·原發(fā)性甲狀旁腺功能亢進(jìn)癥的外科治療武正炎沈美萍陸輝210029江蘇，南京醫(yī)科大學(xué)第一附屬醫(yī)院江蘇省人民醫(yī)院普外科內(nèi)分泌乳腺外科專業(yè)組【摘要】目的總結(jié)原發(fā)性甲狀旁腺功能亢進(jìn)癥的診斷與治療經(jīng)驗。方法回顧性分析1962年～2007年7月我院手術(shù)治療的84例原發(fā)性甲狀旁腺功能亢進(jìn)癥的臨床資料。結(jié)果聯(lián)合B超、99mTc-MIBI核素掃描定位診斷率達(dá)到96.5%。雙側(cè)探查甲狀旁腺瘤切除12例，單側(cè)探查甲狀旁腺瘤切除43例，頸部小切口甲狀旁腺瘤切除19例。腺瘤78例，其中77例為單發(fā)腺瘤，甲狀旁腺增生4例，甲狀旁腺癌1例，1例探查無明顯病變。術(shù)后無嚴(yán)重并發(fā)癥，2例持續(xù)甲狀旁腺機(jī)能亢進(jìn)，其
2、余患者血鈣降低或恢復(fù)正常，2例復(fù)發(fā)。手術(shù)治療成功率95.2%。結(jié)論B超、99mTc-MIBI掃描是有效的術(shù)前定位檢查手段；單側(cè)甲狀旁腺探查手術(shù)是有效的手術(shù)方法；頸部小切口甲狀旁腺瘤切除對于定位診斷明確的患者有很好的應(yīng)用前景。【關(guān)鍵詞】原發(fā)性甲狀旁腺功能亢進(jìn)；手術(shù)治療；雙側(cè)探查；單側(cè)探查；頸部小切口?！局袌D分類號】R653ThesurgicaltreatmentofprimaryhyperparathyroidismWUZheng-yan,SHENMei-ping,LUHui.DivisionofEndocrineandBreastSurgery,DepartmentofGeneralS
3、urgery,theFirstAffiliatedHospitalofNanjingMedicalUniversity,JiangsuProvinceHospital,Nanjing,210029【Abstract】ObjectivesTosummarizetheexperienceofdiagnosisandsurgicaltreatmentofprimaryhyperparathyroidisminJiangsuProvinceHospital.Method84casesofprimaryhyperparathyroidismdiagnosedandtreatedsurgicall
4、yfrom1962through2007werestudiedretrospectively.Results84casesagedfrom11to73underwentoperationsforhyperparathyroidismandwereidentifiedwithadenomain78cases,hyperplasiain4casesandcarcinomain1case.Allpatentsexcept4hadclinicalpresentation.30caseswerelocalizedpreoperativelybysestamibiscaningcombinedwi
5、thultrasonographysince1995and29showedpositiveresultsinbothexaminationasconfirmedbypathology.Bilateralexplorationswereperformedin12patientsand43caseswereexploredunilaterally,19casesunderwentminimallyinvasiveparathyroidectomythrougha3cmincision,4patientssufferedfromrecurrentorpersistenthyperparath
6、yroidism.ConclusionsPreoperativelocalizationisveryhelpfulbysestamibiscaningcombinedwithultrasounography;Unilateralexplorationforparathyroidadenomaisfeasible;Minimallyinvasiveparathyroidectmythoughminimalincisionisakindofimprovingprocedureforthelocalizedparathyroidadenoma.【Keywords】primaryhyperpa
7、rathyroidism(PHPT);surgicaltreatment;bilateralexploration;unilateralexploration;Minimally;minimalcervicalincision原發(fā)性甲狀旁腺功能亢進(jìn)癥（primaryhyperparathyroidism，PHPT）是因甲狀旁腺腺瘤、增生或癌引起甲狀旁腺素（PTH）自主性分泌過多而導(dǎo)致的以鈣磷代謝紊亂、以骨和（或）腎病變?yōu)橹饕R床特征的疾病。近年
