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目的:探讨原发性甲状旁腺功能亢进（primary hyperparathyroidism，PHPT）中甲状旁腺多腺体病变（parathyroid multiglandular disease，PTMGD）的临床特征，诊断方法，治疗方式及预后。方法:回顾性分析2015年12月至2023年7月天津医科大学总医院普通外科行手术治疗的29例PTMGD患者的临床资料，包括患者术前、术后血钙和甲状旁腺素，主要临床表现，累及其他系统情况，主要病理类型，各种检查的准确性，及术后预后情况等，并和同期手术的291例单腺体病变患者进行了对比。采用SPSS 25对数据进行统计分析。结果:PTMGD组发病年龄为（52.7±1.9）岁，单腺体病变组发病年龄为（56.6±0.7）岁，PTMGD患者发病年龄更低， P=0.047。PTMGD肿瘤直径为（2.05±0.1）cm，单腺体病变肿瘤直径为（2.34±0.6）cm，PTMGD肿瘤直径更小（ P=0.006）。PTMGD术前血钙为（2.56±0.59）mmol/L，单腺体病变为（2.70±0.58）mmol/L，PTMGD患者血钙低于单腺体病变患者（ P=0.045）。PTMGD患者术前甲状旁腺素（parathyroid hormone，PTH）、血钙和Win值都与肿瘤最大直径呈正相关（ R值分别为0.362、0.223、0.352）。本组病例应用颈部超声、颈部增强CT及甲状旁腺核素显像等检查方法对病变的甲状旁腺进行定位诊断，PTMGD患者准确率分别为（14/25）56%、（10/19）53%和（11/24）46%，单腺体病变患者准确率为（233/250）89%、（131/152）96%和（223/232）86%，PTMGD准确率小于单腺体病变且差异有统计学意义（ P值均<0.001）。在PTMGD患者中三种检查联合定位诊断的准确率提高为（13/18）72%。PTMGD组甲状旁腺增生45/72（63%）；单腺体病变组甲状旁腺增生18/291（6%），PTMGD组甲状旁腺增生的比例高于单腺体病变组（ P<0.001）；单腺体病变组中甲状旁腺腺瘤为237/291（82%），高于PTMGD组的24/72（33%）（ P<0.001）。23例PTMGD患者进行随访，其中9例术后甲状旁腺素出现轻度升高，1例出现甲状旁腺功能减退的症状。 结论:PHPT中多腺体病变患者的发病年龄偏低，且生化检查相对温和，术前准确定位所有病变腺体较困难，故应行充分术前评估，及时发现家族性多发内分泌腺瘤患者，同时对可疑多腺体病变患者术中应行双侧甲状旁腺探查。

Objective:To investigate the clinical features, diagnostic methods, treatment modalities, and prognosis of parathyroid multiglandular disease (PTMGD) in primary hyperparathyroidism (PHPT) .Methods:The clinical data of 29 patients with PTMGD who underwent surgery at the General Surgery Department of the Tianjin Medical University General Hospital from Dec. 2015 to Jul. 2023 were retrospectively analyzed, including the patients' preoperative and postoperative blood calcium and parathyroid hormone, the main clinical manifestations, the involvement of other systems, the main types of pathology, the accuracy of the various examinations, and the postoperative prognosis, etc., and were compared with the 291 patients who had undergone surgery for single-glandular lesion patients were compared. SPSS25 was used to analyze the data.Results:The age of onset of PTMGD was 52.7±1.9 years compared to 56.6±0.7 years in patients with monoglandular disease, P=0.047. Tumor diameter of PTMGD was (2.05±0.1) cm and (2.34±0.6) cm of monoglandular disease, P=0.006. The preoperative blood calcium was (2.56±0.59) mmol/L in PTMGD and (2.70±0.58) mmol/L in monoglandular disease, P=0.045. Preoperative parathyroid hormone (PTH), blood calcium, and Win values were positively correlated with maximum tumor diameter in patients with PTMGD (R-values of 0.362, 0.223, and 0.352, respectively) .Neck ultrasound, neck-enhanced CT and parathyroid nuclear imaging were used to localize and diagnose the diseased parathyroid glands in this group of cases.The accuracy rates were (14/25) 56%, (10/19) 53% and (11/24) 46% in patients with PTMGD, while in patients with monoglandular disease, the accuracy rates were (233/250) 89%, (131/152) 96% and (223/232) 86%. PTMGD accuracy rate was less than that of monoglandular disease,and was statistically significant ( P-value was less than 0.001 in all cases) .The accuracy of the combined localization diagnosis of the three tests in patients with PTMGD was then improved to (13/18) 72%. The pathology of PTMGD was predominantly parathyroid hyperplasia, 45/72 (63%), compared to that of monoadenopathy 18/291 (6%), P<0.001. Parathyroid adenomas predominated in patients with monoadenopathy compared to that of PTMGD, 237/291 (82%) vs. 24/72 (33%), and the proportion of parathyroid adenomas in patients with monoadenopathy was higher than that in patients with PTMGD, P<0.001. 23 patients with PTMGD were followed up, of whom 9 showed mild elevation of parathyroid hormone postoperatively, and 1 patient showed signs of hypoparathyroidism. Conclusion:The low age of onset of multiglandular lesions in primary hyperparathyroidism, mild biochemical tests, and the difficulty of accurately locating all lesions preoperatively warrant adequate preoperative evaluation to promptly identify patients with familial multiple endocrine adenomas, as well as intraoperative bilateral parathyroid exploration in patients with suspected multiglandular lesions.