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目的:探讨原发性甲状旁腺机能亢进症的诊断和手术方法。方法:对33例原发性甲状旁腺机能亢进症的患者的临床表现、实验室检查和术前、术中定位方法及手术治疗进行了回顾性分析总结。结果:持重部位骨关节疼痛、多发骨折为其主要征象,实验室检查有血钙、血PTH、血碱性磷酸酶及尿钙、尿磷升高和血磷降低。X线主要表现为骨质疏松、骨质变薄。B超、CT及99mTc造影三项结合可使术前定位准确率达90.9%。结论:原发性甲状旁腺机能亢进症需结合临床症状及辅助检查。术前、术中的准确定位及冰冻病理的定性检查是手术成功的关键。一侧甲状旁腺中仅有一个病变者可只行单侧探查。
Objective: To investigate the diagnosis and surgical methods of primary hyperparathyroidism. Methods: The clinical manifestations, laboratory tests, preoperative and intraoperative positioning methods and surgical treatment of 33 patients with primary hyperparathyroidism were analyzed retrospectively. Results: The bone and joint pain in the weight-bearing area was the main symptom. The laboratory tests included serum calcium, blood PTH, blood alkaline phosphatase and urinary calcium, elevated urinary phosphorus and decreased blood phosphorus. X-ray is mainly manifested as osteoporosis, bone thinning. B-ultrasound, CT and 99mTc angiography combined with three preoperative positioning accuracy rate of 90.9%. Conclusion: Primary hyperparathyroidism need to be combined with clinical symptoms and laboratory examinations. Preoperative and intraoperative accurate positioning and frozen pathological qualitative examination is the key to successful operation. Only one lesion on one side of the parathyroid gland may be examined unilaterally.