原发性甲状旁腺功能亢进症的诊断和治疗

发布时间：2018-09-14 15:53

【摘要】：目的:探究原发性甲状旁腺功能亢进症的临床表现,定性与定位诊断中的相关辅助检查及其意义以及手术治疗的效果。方法:原发性甲状旁腺功能亢进症常用的辅助检查包括:血清PTH、血清钙的检测,颈部彩超,ECT,骨密度检查,泌尿系彩超等。本文通过收集81例原发性甲状旁腺功能亢进症病例,分析其临床表现,并整理所采用的辅助检查方法及相应的检出率,以及经手术及术后病理证实后反映该检查的准确率,和术后复查PTH反映手术对于原发性甲旁亢的治疗效果。结果:原发性甲旁亢的临床表现包括骨骼系统症状、泌尿系统症状、消化系统症状、神经肌肉系统症状,也可表现为临床无明显症状,仅血钙升高。常用辅助检查,如血清PTH、血清钙的检测、颈部彩超、放射性核素检查、骨密度检查、泌尿系彩超等相关检查对于不同类型的原发性甲旁亢具有较高的诊断价值。PHPT的定性诊断主要依据为血清PTH、血清钙的检测,颈部彩超和核素检查可以较准确的发现甲状旁腺腺瘤及甲状旁腺增生,其中彩超检查较为简单、经济,但其缺点为难以发现较小的病灶,且对于部分甲状旁腺腺瘤和甲状腺结节很难鉴别;核素检查对于甲状旁腺腺瘤和甲状旁腺增生的诊断更为直观,但其检查的复杂性及价格的相对昂贵使其应用范围较小,不适用于筛查。对于以骨型、肾型为首发症状的原发性甲状旁腺功能亢进症的患者,通常根据其表现采用相应检查,如骨密度检查、泌尿系彩超等作为初步筛查方法。结论:PHPT可分为无症状型和症状型PHPT;血清甲状旁腺素和血清钙测定是原发性甲旁亢的主要定性诊断方法,颈部彩超及放射性核素检查等为主要的定位诊断方法。根据病情联合应用以上不同检查,对于原发性甲旁亢的诊断具有重要价值。手术治疗是原发性甲旁亢的首选治疗方法,可显著降低血钙和血PTH。
[Abstract]:Objective: to investigate the clinical manifestation of primary hyperparathyroidism, the related auxiliary examination in qualitative and localization diagnosis and its significance, and the effect of surgical treatment. Methods: the common auxiliary examination of primary hyperparathyroidism included: serum PTH, serum calcium detection, neck color Doppler ultrasound, bone mineral density examination, urinary system color Doppler ultrasound and so on. 81 cases of primary hyperparathyroidism were collected and their clinical manifestations were analyzed. And postoperative PTH reflect the effect of operation on primary hyperparathyroidism. Results: the clinical manifestations of primary hyperparathyroidism included the symptoms of skeletal system, urinary system, digestive system and neuromuscular system. Commonly used auxiliary examination, such as serum PTH, serum calcium detection, neck color ultrasound, radionuclide examination, bone mineral density examination, The diagnostic value of urography for different types of primary hyperparathyroidism is higher. The qualitative diagnosis of PHPT is mainly based on the detection of serum PTH, serum calcium. Color Doppler ultrasonography and radionuclide examination can accurately detect parathyroid adenoma and parathyroid hyperplasia, in which color Doppler ultrasound is relatively simple and economical, but its disadvantages are that it is difficult to find small lesions. The diagnosis of parathyroid adenoma and parathyroid hyperplasia is more intuitive than that of nuclide examination, but the complexity of the examination and the relatively high price of the examination make the scope of its application smaller, and the diagnosis of parathyroid adenoma and hyperparathyroidism is more obvious than that of radionuclide examination. Not suitable for screening. For the patients with primary hyperparathyroidism with bone type and renal type as the first symptom, the corresponding examination is usually used according to their manifestations, such as bone density examination, urologic color ultrasound as the initial screening method. Conclusion the determination of serum parathyroid hormone (PTH) and serum calcium in PHPT; can be divided into asymptomatic and symptomatic PHPT;, which are the main qualitative diagnostic methods for primary hyperparathyroidism, and the cervical color Doppler ultrasound and radionuclide examination are the main diagnostic methods for the diagnosis of hyperparathyroidism. Combined use of the above examination is of great value in the diagnosis of primary hyperparathyroidism. Surgical treatment is the first choice in the treatment of primary hyperparathyroidism, which can significantly reduce serum calcium and PTH..
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R582.1

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