| Objective:To reveal the clinical characteristics of parathyroid tumors and analysis its surgical therapy effect.Methods: The follow-up data of 43 cases of parathyroid tumors received treatment in general surgery ward of The First Affiliated Hospital to Dalian Medical University from January 2002 to February 2011 were enrolled into retrospective analysis.Results: This research involve 29 cases of parathyroid adenomas(67.4%),13 cases of parathyroid cysts(30.2%)and 1 case of parathyroid cancer (2.32%).All the cases,except 13 cases of cysts, are accompanied by symptoms of hyperparathyroidism, which mainly characterized by neck mass, fracture, bone pain,urinary calculi, nausea ,vomiting and fatigue, etc,and show the clinical symptoms of hypercalcemia and high parathyroid hormone(PTH) levels without hyperparathyroidism;8 cases are characterized by bone and joint lesions;1 case is characterized by urinary calculi;5 cases are characterized by intractable nausea and vomiting;1 case is mixed with the symptoms of bone lesions and nausea,vomiting,fatigue;1 case is mixed with the symptoms of osseous and urinary calculi.It's depended on ultrasonic imaging,CT scan and 99mTC-MIBI for preoperative positioning,of which diagnostic accuracy respectively are 68.5%,76.4% and 75%;The laboratory examinations of blood calcium, phosphate and PTH are needed for qualitative diagnosis.In this research,the blood calcium of 30 cases(29 cases of parathyroid adenomas and 1 case of parathyroid cancer)is higher than normal level(2.1-2.6mmol/L),of which the lowest level is 2.79 mmol/L,and the highest level is 3.85mmol/L;The blood phosphate of 26 cases is lower than the normal level(0.96-1.62mmol/L);PTH of all cases is higher than normal level(15-65 mmol/L). The biochemical blood test of the cases accompnied by hyperparathyroidism after surgical therapy shows that blood calcium and PTH level falls with the blood phosphate level climbs to a certain extent,and most patients manifest the symptoms of hypocalcemia,such as peri-mouth and extremity numbness,whose blood calcium can rise to the normal level when received calcium gluconate injection or oral calcium taking during 1 weeks to 3 moths after the surgery.46 patients all have received surgical theray.Amone the 29 cases of parathyroid adenomas received parathyroid adenoma resection,11 cases received lobectomy of thyroid at the same time after a unilateral parathyroid exploration.Amone the 13 cases of parathyroid cysts received cystectomy,1 case received excision of the contralateral thyroid tumor. 1 case of parathyroid cancer received exploratory operation of parathyroid tumor,homolateral parathyroid,isthmus and homolateral lobe of thyroid.30 cases manifested hyperparath- yroidism are without recurrence and get relieved after the surgery.1 case of parathyroid cancer which was followed up for one year and 5 months showed disease-free survival.Conclusion: 1.There lack of specific clinical symptoms of parathyroid tumors.Clinicians should be alert of the patients suffered from bone and joint pain,repeated attacks of urinary calculi and intractable nausea and vomiting. 2. The laboratory examinations of blood calcium, phosphate and PTH are reliable for qualitative diagnosis.B-ultrasonic imaging is preferred in preoperative positioning,how- ever CT and 99mTC-MIBI scan can be applied when necessary. 3.Surgical resection is the predominant therapy for parathyroid tumors,simple cystectomy is enough for parathyroid cysts,it's feasible to perform a unilateral parathyroid exploratory operation for parathyroid adenomas with an accurate preoperative positioning and a intraoperative frozen section.For early stage of parathyroid cancer,it's recommended to perform an excision of isthmus and homolateral lobe of thryroid,peripheral soft tissues should be included.Prophylactic neck dissection is not advisable,however extensive resection is necessary for the cases with cervical lymph node metastasis or post-surgical recurrence. |
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