协和医学杂志

2013, (03)

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甲状腺内异位甲状旁腺病变的定位诊断和手术治疗
The Localization and Surgical Treatment of Intrathyroidal Parathyroid Lesions with Primary hyperparathyroidism

胡亚;廖泉;牛哲禹;赵建国;赵玉沛

摘要(Abstract):

目的 回顾性分析甲状腺内异位甲状旁腺肿瘤这一少见疾病的定位诊断和手术治疗策略。方法 检索2003年9月至2012年9月北京协和医院诊断治疗的甲状旁腺功能亢进病例资料,分析甲状腺内异位甲状旁腺肿瘤的发生率以及临床诊治特点。 结果 7例甲状腺内异位甲状旁腺患者接受手术切除治疗,并得到病理诊断证实。1例患者术前出现高钙危象。7例患者均在术前通过超声发现甲状腺内占位,其中5例患者在超声诊断中提示可能为甲状旁腺。6例患者术前行MIBI SPECT显像检查,其中5例发现异常增高区域。5例患者在术前行颈部CT发现甲状腺内类圆形病灶,但无法诊断异位甲状旁腺。术后病理诊断甲状旁腺腺瘤4例,甲状旁腺腺癌2例,甲状旁腺增生1例。术后患者无复发迹象,1例反复三次甲状旁腺手术的患者术后出现轻微声音嘶哑。 结论 对于甲状腺内异位甲状旁腺这类少见的病例,术前诊断非常困难,需结合多种定位手术,提高手术疗效,减少盲目探查风险。
Objective The intrathyroidal parathyroid lesion with primary hyperparathyroidism is a rare condition in China. The strategy of diagnosis and surgery for intrathyroidal parathyroid lesions was summarized. Methods The database of patients undergoing parathyroidectomy between September 2003 and September 2012 in Peking Union Medical College Hospital was analyzed retrospectively for intrathyroidal parathyroid lesions with primary hyperparathyroidism. Results The incidence of intrathyroid parthyroid was 1.28% in our series (7/547), including two female and two male patients. Ultrasound evaluation revealed lesion in thyroid in all seven patients before operations. A planar parathyroid scan after the administration of technetium sestamibi in 6 patients demonstrated positive results in 5 patients. Cervical computed tomography (CT) revealed lesion with lower density in thyroid. Pathologic examinations of the resected lesions revealed adenoma (n=4), adenocacinoma (n=2) and hyperplasia (n=1). Conclusions Despite improved imaging technology,localization of intrathyroidal parathyroid lesion still remains difficult for patients with primary hyperparathyroidism. Multiple imaging examinations should be utilized before operation reasonably to increase the accuracy of localization.

关键词(KeyWords): |异位甲状旁腺|甲状腺|诊断|手术|
|ectopic parathyroid|hyperparathyroidism|diagnosis|surgery|

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作者(Author): 胡亚;廖泉;牛哲禹;赵建国;赵玉沛

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