【摘要】：目的:探究原發(fā)性甲狀旁腺功能亢進(jìn)癥的臨床表現(xiàn),定性與定位診斷中的相關(guān)輔助檢查及其意義以及手術(shù)治療的效果。方法:原發(fā)性甲狀旁腺功能亢進(jìn)癥常用的輔助檢查包括:血清PTH、血清鈣的檢測(cè),頸部彩超,ECT,骨密度檢查,泌尿系彩超等。本文通過(guò)收集81例原發(fā)性甲狀旁腺功能亢進(jìn)癥病例,分析其臨床表現(xiàn),并整理所采用的輔助檢查方法及相應(yīng)的檢出率,以及經(jīng)手術(shù)及術(shù)后病理證實(shí)后反映該檢查的準(zhǔn)確率,和術(shù)后復(fù)查PTH反映手術(shù)對(duì)于原發(fā)性甲旁亢的治療效果。結(jié)果:原發(fā)性甲旁亢的臨床表現(xiàn)包括骨骼系統(tǒng)癥狀、泌尿系統(tǒng)癥狀、消化系統(tǒng)癥狀、神經(jīng)肌肉系統(tǒng)癥狀,也可表現(xiàn)為臨床無(wú)明顯癥狀,僅血鈣升高。常用輔助檢查,如血清PTH、血清鈣的檢測(cè)、頸部彩超、放射性核素檢查、骨密度檢查、泌尿系彩超等相關(guān)檢查對(duì)于不同類(lèi)型的原發(fā)性甲旁亢具有較高的診斷價(jià)值。PHPT的定性診斷主要依據(jù)為血清PTH、血清鈣的檢測(cè),頸部彩超和核素檢查可以較準(zhǔn)確的發(fā)現(xiàn)甲狀旁腺腺瘤及甲狀旁腺增生,其中彩超檢查較為簡(jiǎn)單、經(jīng)濟(jì),但其缺點(diǎn)為難以發(fā)現(xiàn)較小的病灶,且對(duì)于部分甲狀旁腺腺瘤和甲狀腺結(jié)節(jié)很難鑒別;核素檢查對(duì)于甲狀旁腺腺瘤和甲狀旁腺增生的診斷更為直觀,但其檢查的復(fù)雜性及價(jià)格的相對(duì)昂貴使其應(yīng)用范圍較小,不適用于篩查。對(duì)于以骨型、腎型為首發(fā)癥狀的原發(fā)性甲狀旁腺功能亢進(jìn)癥的患者,通常根據(jù)其表現(xiàn)采用相應(yīng)檢查,如骨密度檢查、泌尿系彩超等作為初步篩查方法。結(jié)論:PHPT可分為無(wú)癥狀型和癥狀型PHPT;血清甲狀旁腺素和血清鈣測(cè)定是原發(fā)性甲旁亢的主要定性診斷方法,頸部彩超及放射性核素檢查等為主要的定位診斷方法。根據(jù)病情聯(lián)合應(yīng)用以上不同檢查,對(duì)于原發(fā)性甲旁亢的診斷具有重要價(jià)值。手術(shù)治療是原發(fā)性甲旁亢的首選治療方法,可顯著降低血鈣和血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..
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R582.1

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