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目的探讨尿路结石患者中原发性甲状旁腺机能亢进的诊断和治疗。方法回顾性分析1998年1月至2004年6月因尿路结石就诊,临床诊断原发甲旁亢12例的资料。结果9例病理证实为甲状旁腺腺瘤,男4例,女5例,年龄45.7±11.8岁(26～57),结石病史8.3年±6.4年(0.5～22年)。血钙和PTH明显升高,66%患者血磷降低。B超、CT和99mTC MIBI显像的阳性率和准确率分别为67%、100%、100%和67%、75%、100%。切除腺瘤后,患者血钙和PTH恢复正常。并对另外3例未发现甲状旁腺瘤的患者资料进行分析。结论尿路结石病因为原发甲旁亢者,血钙大于2.96mmol/L,PTH超过正常3.9倍。99mTC MIBI显像是最佳定位检查。手术是治疗原发甲旁亢的有效方法。术后应密切随访尿路结石,必要时予相应治疗。
Objective To investigate the diagnosis and treatment of primary hyperparathyroidism in patients with urolithiasis. Methods The clinical data of 12 cases with primary hyperparathyroidism were retrospectively analyzed from January 1998 to June 2004 due to urinary calculus. Results 9 pathologically confirmed parathyroid adenoma, 4 males and 5 females, aged 45.7 ± 11.8 years (26 ~ 57), history of stones 8.3 years ± 6.4 years (0.5 ~ 22 years). Blood calcium and PTH were significantly higher, 66% of patients with decreased phosphorus. The positive rate and accuracy of B ultrasound, CT and 99mTC MIBI imaging were 67%, 100%, 100% and 67%, 75% and 100% respectively. After removal of adenoma, patients with serum calcium and PTH returned to normal. And the other 3 cases of patients without parathyroid tumor data were analyzed. Conclusion Urinary tract stones are caused by primary hyperparathyroidism, with serum calcium greater than 2.96mmol / L and PTH exceeding 3.9 times normal. 99mTC MIBI imaging is the best positioning check. Surgery is an effective method of treating primary hyperparathyroidism. Postoperative urinary tract stones should be followed up, if necessary, to the appropriate treatment.