Wells S A, Leight G S, Hensley M, Dilley W G
Ann Surg. 1985 Nov;202(5):533-8. doi: 10.1097/00000658-198511000-00001.
Eighty-five (23%) of 375 patients undergoing surgery for primary hyperparathyroidism were found to have enlargement (greater than 50 mg) of two or three parathyroid glands. Of 76 patients followed from 12 to 140 months after surgery, eight (10.5%) developed hypercalcemia at 1, 4, 45, 64, 74, 79, 84, and 133 months. In a comparison of pertinent preoperative biochemical and pathologic data between 55 patients with two- or three-gland hyperparathyroidism and 55 age- and sex-matched patients with single-gland hyperparathyroidism, only the preoperative serum phosphate differed significantly, being lower in the patients with single-gland disease (2.4 +/- 0.1 vs. 2.6 +/- 0.1; p less than 0.04). In the eight patients with two- or three-gland hyperparathyroidism who developed postoperative hypercalcemia, the preoperative concentrations of serum calcium were lower (10.8 +/- 0.2 vs. 11.5 +/- 0.2; p less than 0.019), the preoperative concentrations of serum phosphate were higher (3.1 +/- 0.2 vs. 2.5 +/- 0.1; p less than 0.020), and the weights of the excised parathyroid tissues were less (356 +/- 72 mg vs. 1354 +/- 215 mg; p less than 0.02) than those of patients with two- or three-gland disease who did not develop postoperative hypercalcemia, indicating a milder form of hyperparathyroidism. In the 68 patients without recurrent hypercalcemia, there was no tendency for the serum calcium concentration to increase with time. Patients with primary hyperparathyroidism associated with two or three enlarged parathyroid glands have an appreciable incidence of persistent or recurrent hypercalcemia, which may increase even further with longer observation.
375例接受原发性甲状旁腺功能亢进手术的患者中，85例（23%）被发现有两个或三个甲状旁腺增大（大于50mg）。在术后随访12至140个月的76例患者中，有8例（10.5%）分别在术后1、4、45、64、74、79、84和133个月出现高钙血症。在对55例有两个或三个甲状旁腺功能亢进的患者与55例年龄和性别匹配的单发性甲状旁腺功能亢进患者的术前相关生化和病理数据进行比较时，仅术前血清磷酸盐有显著差异，单发性甲状旁腺疾病患者的血清磷酸盐较低（2.4±0.1 vs. 2.6±0.1；p<0.04）。在8例术后出现高钙血症的两个或三个甲状旁腺功能亢进患者中，术前血清钙浓度较低（10.8±0.2 vs. 11.5±0.2；p<0.019），术前血清磷酸盐浓度较高（3.1±0.2 vs. 2.5±0.1；p<0.020），切除的甲状旁腺组织重量较轻（356±72mg vs. 1354±215mg；p<0.02），与术后未出现高钙血症的两个或三个甲状旁腺疾病患者相比，提示甲状旁腺功能亢进症状较轻。在68例无复发性高钙血症的患者中，血清钙浓度没有随时间增加的趋势。伴有两个或三个甲状旁腺增大的原发性甲状旁腺功能亢进患者有相当比例的持续性或复发性高钙血症，随着观察时间延长，其发生率可能会进一步增加。
