原发性甲状旁腺功能亢进合并肾结石的临床分析：附23例报告

Zha Zhen-lei, Qu Feng, Lian Hui-bo, Zhang Gu-tian, Gan Wei-dong, Li Xiao-gong, Lan Hou-jin, Guo Hong-qian

Department of Urology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.

Department of Urology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China. Email:

Zhonghua Wai Ke Za Zhi. 2013 Oct;51(10):887-90.

OBJECTIVE

To discuss the clinical characteristics of primary hyperparathyroidism (PHPT) with kidney stones.

METHODS

The clinical data of 23 cases undergoing diagnostic evaluation and surgery for PHPT combined with kidney stones between January 2004 and February 2012 was retrospectively analyzed. The 23 cases had undergone preoperative parathyroid neck color ultrasound, CT or (99)mTc-methoxy isobutyl isonitrile ((99)mTc-MIBI) diagnosis. The surgical treatment included parathyroid disease and kidney stones. The intravenous calcium, phosphorus and serum intact parathyroid hormone (iPTH) levels, 24 hours urinary calcium concentrations were measured 3 days before and 7 days after surgery.

RESULTS

There were 8 male and 15 female patients. The stone diameter were (3.2 ± 0.7) cm (range 2.1-4.0 cm). All patients did both parathyroid surgery and kidney surgery. The statistical discrepancy of serum calcium (there were (3.31 ± 0.39) mmol/L before surgery and (2.12 ± 0.18) mmol/L at 7 days after surgery, t = 11.26), serum phosphorus ((0.70 ± 0.09) and (1.21 ± 0.21) mmol/L in before and after surgery respectively, t = 10.53), iPTH (there were (28.8 ± 10.0) pmol/L before surgery and (3.6 ± 2.6) pmol/L after surgery, t = 12.83) and 24-hours urine calcium (there were (7.2 ± 3.1) mmol/d before surgery and (3.6 ± 2.5) mmol/d after surgery, t = 8.81) before and after the operation was significant (all P < 0.01). PTH concentration with serum calcium concentration correlation coefficient was r = 0.59 (P < 0.01). Eighteen patients (78.3%) had solitary parathyroid adenomas, two patients (8.7%) had multiple parathyroid adenomas, and three patients (13.0%) had multiglandular hyperplasia confirmed at surgery and histology. During follow-up, 8 patients had stone recurrence and 3 patients were did operation again to deal with renal stone within 2 years. Among them, 7 cases were normal, 1 case of parathyroid adenomas recurrence and reoperation.

CONCLUSIONS

The parathyroid operation may reduce the calculus recurrence remarkably. Early diagnosis and treatment of primary hyperparathyroidism is helpful to reduce the calculus recurrence and preserve the renal function.

目的

探讨原发性甲状旁腺功能亢进症（PHPT）合并肾结石的临床特点。

方法

回顾性分析2004年1月至2012年2月间23例因PHPT合并肾结石接受诊断评估及手术治疗的患者的临床资料。这23例患者术前行甲状旁腺颈部彩色超声、CT或（99）m锝-甲氧基异丁基异腈（（99）mTc-MIBI）诊断。手术治疗包括甲状旁腺疾病及肾结石。分别于术前3天及术后7天测定静脉血钙、磷及血清完整甲状旁腺激素（iPTH）水平、24小时尿钙浓度。

结果

男性8例，女性15例。结石直径为（3.2±0.7）cm（范围2.1 - 4.0 cm）。所有患者均接受了甲状旁腺手术及肾脏手术。手术前后血清钙（术前（3.31±0.39）mmol/L，术后7天（2.12±0.18）mmol/L，t = 11.26）、血清磷（术前（0.70±0.09）mmol/L，术后（1.21±0.21）mmol/L，t = 10.53）、iPTH（术前（28.8±10.0）pmol/L，术后（3.6±2.6）pmol/L，t = 12.83）及24小时尿钙（术前（7.2±3.1）mmol/d，术后（3.6±2.5）mmol/d，t = 8.81）的统计学差异均有显著性（均P < 0.01）。PTH浓度与血清钙浓度的相关系数r = 0.59（P < 0.01）。18例患者（78.3%）为单发甲状旁腺腺瘤，2例患者（8.7%）为多发甲状旁腺腺瘤，3例患者（13.0%）经手术及组织学检查确诊为多腺体增生。随访期间，8例患者出现结石复发，3例患者在2年内再次接受手术处理肾结石。其中，7例恢复正常，1例甲状旁腺腺瘤复发并再次手术。