Wallfelt C, Ljunghall S, Bergström R, Rastad J, Akerström G
Department of Surgery, University Hospital, Uppsala, Sweden.
Surgery. 1990 Jan;107(1):13-9.
In 570 patients with sporadic primary hyperparathyroidism, the age, sex, symptoms, and preoperative serum calcium values were related to the histopathologic diagnoses, operative findings, and the extent and outcome of parathyroid surgery. Renal stone formation was especially prevalent in younger patients with slight hypercalcemia and parathyroid chief cell hyperplasia, whereas neuromuscular and psychiatric disturbances were overrepresented among older women with higher serum calcium values. Serum calcium concentration was inversely correlated to the proportional incidence of chief cell hyperplasia and positively correlated to the glandular weight of both adenomas and hyperplasias. Glandular size was markedly irregular in chief cell hyperplasia, with increased gland weights of no more than two glands in 78% of patients. During follow-up, for as long as 27 years, normocalcemia was obtained in 91% of patients with adenomas, with failures mainly depending on difficulties in identifying the parathyroid glands. The rate of normocalcemia was lower (80%) among patients with hyperplasia, but an inability to visualize the glands was not a major cause of failure. In patients with hyperplasia with asymmetric and more markedly enlarged glands, it appeared sufficient to remove only the enlarged glands, whereas the findings advocated a subtotal 3- to 3.5-gland resection in patients with more symmetrically or less enlarged hyperplastic glands.
在570例散发性原发性甲状旁腺功能亢进患者中，年龄、性别、症状及术前血清钙值与组织病理学诊断、手术所见以及甲状旁腺手术的范围和结果相关。肾结石形成在血钙轻度升高且伴有甲状旁腺主细胞增生的年轻患者中尤为普遍，而神经肌肉和精神障碍在血清钙值较高的老年女性中更为常见。血清钙浓度与主细胞增生的比例发生率呈负相关，与腺瘤和增生的腺体重量呈正相关。主细胞增生时腺体大小明显不规则，78%的患者腺体重量增加不超过两个腺体。在长达27年的随访中，91%的腺瘤患者实现了血钙正常，失败主要取决于甲状旁腺的识别困难。增生患者的血钙正常率较低（80%），但无法看到腺体并非失败的主要原因。在腺体不对称且明显增大的增生患者中，仅切除增大的腺体似乎就足够了，而研究结果主张对腺体更对称或增大程度较小的增生患者进行3至3.5个腺体的次全切除。
