Petti G H
Division of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, California.
Otolaryngol Clin North Am. 1990 Apr;23(2):339-55.
Primary hyperparathyroidism can be caused by a solitary parathyroid adenoma and sometimes by hyperplastic parathyroid glands, multiple adenomas, or carcinoma. In the majority of patients, the diagnosis is made tentatively by chemistry profiles that show elevated serum calcium. It is confirmed by repeated serum calcium values and PTH determination. The parathyroid abnormality, if an adenoma, can usually be localized preoperatively by thallium-technetium scan, ultrasound, or computed tomography. In the case of persistent disease with hypercalcemia, an angiogram with selective venous sampling for PTH is helpful. At exploration, both sides of the neck may need exploration. A unilateral procedure may be sufficient, if the preoperative localization tests are confirmatory and if biopsy of another "normal" gland shows normal histologic findings. During the postoperative period, suction drains will lessen the likelihood of hematoma formation and serum calcium levels are monitored for the first 3 to 5 days. Symptomatic patients with low calcium levels receive intravenous and oral calcium supplements until values are brought to the low-normal range. Supplements are tapered as the calcium in the serum rises. The majority of patients who undergo parathyroid surgery will benefit both symptomatically and metabolically.
原发性甲状旁腺功能亢进可由单个甲状旁腺腺瘤引起，有时也可由甲状旁腺增生、多个腺瘤或癌引起。大多数患者通过显示血清钙升高的化学检查初步诊断。通过反复检测血清钙值和甲状旁腺激素（PTH）测定得以确诊。如果是腺瘤，甲状旁腺异常通常可通过铊 - 锝扫描、超声或计算机断层扫描在术前定位。对于高钙血症持续存在的病例，进行选择性静脉取血测定PTH的血管造影有助于诊断。手术探查时，颈部两侧可能都需要探查。如果术前定位检查得到证实，且对另一个“正常”腺体的活检显示组织学结果正常，单侧手术可能就足够了。术后，引流管可减少血肿形成的可能性，术后头3至5天监测血清钙水平。有症状的低钙血症患者接受静脉和口服钙剂补充，直至血钙值恢复到略低于正常范围。随着血清钙升高，逐渐减少钙剂补充量。大多数接受甲状旁腺手术的患者在症状和代谢方面都会受益。
