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甲状旁腺肿瘤与原发性甲状旁腺功能亢进症研究

来源:原创论文网 添加时间:2019-05-09

  中文摘要

  甲状旁腺肿瘤与原发性甲状旁腺功能亢进症研究

  39 例甲状旁腺肿瘤的临床特点及外科治疗分析目的:研究甲状旁腺肿瘤的流行病学特征、临床特点、手术治疗方式及预后。

  方法:收集于2012年1月~2017年12月间就诊于我校某附院的甲状旁肿瘤患者39例的病例资料,对其临床特点、手术治疗方式、预后等诊疗信息进行回顾性分析。

  结果:本组患者共39例,平均年龄455岁,以51~60岁区间段最多;其中男患8例,女患31例,男女之比:1:3875。肿瘤的首发症状以PHPT相关症状最多见(74%,29/39),压迫症状(18%,7/39),体检发现(8%,3/39)。所有病例均为单发肿瘤,颈部彩超对肿瘤的诊断准确率为846%(33/39),超声中误诊病例多以甲状旁腺囊肿为主,误诊率达50%(4/8);核素显像对于合并PHPT者的定位诊断率为100%。CT的定位诊断准确率约为619%(13/21)。39例患者均在全麻气管插管下行手术治疗,腔镜手术11例,开放28例。对比腔镜及开放性手术在甲状旁腺腺瘤治疗中的应用,二者在手术时间(p>005)、血PTH下降程度(p>005)上均未见统计学差异。术后病理诊断30例腺瘤,1例腺癌和8例囊肿,其中8例甲状旁腺囊肿均为非功能性,28例腺瘤及1例腺癌伴有原发性甲状旁腺功能亢进,术前血PTH不同程度升高,术后与术前相比有显著下降(p<001),术后连续监测血PTH发现有缓慢升高趋势;术前22例血钙升高较明显,术后显著下降(p<001),超过正常范围下限;19例血磷低于正常者,术后均恢复正常(p<005)。术后所有39例患者均获得随访,未见肿瘤复发。

  结论:甲状旁腺肿瘤临床罕见,首发症状变化多样,临床各科医师需对甲状旁腺肿瘤有充分的认识,提高诊断准确率,避免延误治疗。

  颈部彩超及甲状旁腺显像(99mTc-MIBI核素扫描)对甲状旁腺肿瘤的定位诊断有重要价值,甲状旁腺肿瘤经手术治疗后可获得满意的治疗效果,手术并发症发生率低,预后大都良好。腔镜手术可用于对美容有要求的腺瘤患者。

  关键词:甲状旁腺肿瘤,原发性甲状旁腺功能亢进,手术治疗,预后

临床医学论文

  Abstract

  The clinical analysis of 39 cases with parathyroidtumorsObjective: To probe into the epidemiological characteristics, clinical symptoms and signs, different types of surgery treatment and prognosis of parathyroid tumors

  Method: To collect the clinical information of 39 cases ofparathyroid tumors ,which were diagnosised and treated in Theaffiliated hospital of our university from Jan 2012 to Dec 2017 andthen the collected data were analyzed retrospectively

  Results: The total simple size in this survey was 39 cases ,the average age of all patients was 455 years old and the most common age span was the fifth decades There were8 male patients and 31 female patients, and the ratio of menand women was 1:3875 The occurrence rate of the initial symptoms of the tumors vary greatly: symptoms of PHPT (74%,29/39), and the tumor-mass effects (18%, 7/39), and by thephysical examination (8%, 3/39)All cases were performed as single tumor,The diagnostic accuracy of cervical colorful ultrasonography was 846% (33/39), and the number of misdiagnosed cases in ultrasound was mainly parathyroid cyst, and the misdiagnosis rate was 50% (4/8) 99mTc-MIBI imaging has a 10 0% localization diagnostic rate for patients who combine withPHPT The diagnostic accuracy of CT was about 619% (13/21) All of the 39 patients were treated by surgical operation with General anesthesia,including 28 cases of regular operation,11 cases of endoscopic parathyroidectomy via breast areolaapproach Compared with endoscopic and traditional open surgery in the treatment for parathyroid adenoma, the operation time (p>005) and the decrease degree of PTH (p>005) , nostatistical differences were observed Postoperative pathological diagnosis of 39 tumors containing 30 adenoma,1 carcinomaand 8 cysts, all 8 parathyroid cysts were non-functional; 28adenoma and 1 carcinoma were combine with primary hyperparathyroidism, the level of PTH increased in some degree, and decreased to normal level after operation(p<001),then hada slowly increasing tendency Serum calcium of 22 cases andserum phosphate of 19 cases from all 29 PHPT cases wereabnormal and returned to almost normal level after operation

  All 39 patients were followed up after surgery, and no indication of tumor recurrence was found

  Conclusion: Parathyroid tumor is a rare clinical entity withmany of its aspects needed to be elucidated, and its initialsymptoms vary widely Clinicians should have a full understanding of parathyroid tumors, to improve diagnostic accuracy and avoiddelayed treatment There is significant value in the localization ofparathyroid tumors by the ultrasonography of the neck and theimaging of the parathyroid gland (99mTc-MIBI), After surgicaltreatment for patients with parathyroid tumor, satisfactorytherapeutic effect can be obtained, the incidence of surgicalcomplications is low, and the prognosis is mostly good Endoscopicsurgery can be used to treat patients with adenomas who requiringcosmetic surgery

  Keywords:Parathyroid tumor, Hyperparathyroidism, Surgical treatment,Prognosis

  目录

  第 1 章 引言

  11 研究背景

  甲状旁腺肿瘤(parathyroid tumor)属于内分泌系统肿瘤,相对于其他肿瘤罕见,占所有内分泌系统肿瘤的比例也较低。大部分甲状旁腺肿瘤可引起原发性甲状旁腺功能亢进(heperparathyroidism,PHPT),出现骨关节痛、肾结石等以骨、肾功能受损为主的临床表现,并可涉及脑、胃肠道、心血管等全身多系统,而颈部占位性病变的表现一般不明显。因其病变累及全身多个系统,临床表现复杂多样,颈部原发病灶常常被掩盖、忽视,导致诊断困难,误诊率较高。文章收集自2012年1月~2017年12月间于我校某附属医院就诊并行手术治疗的甲状旁腺肿瘤患者39例,对其临床资料进行回顾性分析,并结合2016年美国内分泌医师协会发布的《甲状旁腺功能亢进的诊疗指南》

  及近10年国内、外相关文献,对甲状旁腺肿瘤及PHPT的病因学、组织病理学、诊治方案等进行综述及分析,旨在加强医务工作者对该类疾病的认识,以早期、合理诊治,改善预后。

 【由于本篇文章为硕士论文,如需全文请点击底部下载全文链接】

  1.2 综述:甲状旁腺肿瘤与原发性甲状旁腺功能亢进症
  1.2.1 甲状旁腺的解剖学、组织学
  1.2.2 甲状旁腺肿瘤的病理学特征
  1.2.3 甲状旁腺肿瘤的发病机制
  1.2.4 甲状旁腺肿瘤合并 PHPT 的诊断
  1.2.5 甲状旁腺肿瘤合并 PHPT 的治疗

  第 2 章 资料和方法

  2.1 一般资料
  2.2 辅助检查
  2.3 手术方式
  2.4 统计学方法

  第 3 章 结果

  3.1 一般资料
  3.2 临床表现
  3.3 病理结果
  3.4 影像学检查结果
  3.5 不同治疗方式对比
  3.6 术前及术后血钙、血磷及血 PTH 变化比较
  3.7 疗效随访

  第 4 章 讨论

  4.1 流行病学特点
  4.2 临床表现
  4.3 术前诊断
  4.3.1 实验室检查
  4.3.2 影像学检查
  4.3.3 穿刺活检
  4.4 治疗方案
  4.4.1 外科治疗
  4.4.2 放疗、化疗在甲状旁腺癌中的应用
  4.5 治疗效果及预

  第 5 章 结论

  1甲状旁腺肿瘤临床罕见,首发症状变化多样,以骨、关节病变较多见,女性发病率高于男性,发病年龄多在51-60岁之间,常常以下甲状旁腺受累为主。

  2 对于合并PHPT的甲状旁腺肿瘤患者,影像学检查方法首选核素显像(99mTC-MIBI 检查)。颈部增强CT对甲状旁腺肿瘤的影像学诊断准确率较低。

  3甲状旁腺肿瘤预后大都较好。对于甲状旁腺腺瘤患者,腔镜辅助手术可获得与开放手术相同疗效。

  参考文献

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