Obara T, Okamoto T, Ito Y, Yamashita T, Kawano M, Nishi T, Tani M, Sato K, Demura H, Fujimoto Y
Department of Endocrine Surgery, Tokyo Women's Medical College, Japan.
Surgery. 1993 Dec;114(6):1040-8; discussion 1048-9.
The aim of this study was to characterize patients with pulmonary metastasis of parathyroid carcinoma and to evaluate the long-term effect of surgical and medical therapy.
Seven patients with pulmonary metastasis of parathyroid carcinoma were treated between 1980 and 1992. Six patients underwent resection of pulmonary metastases, and one patient has had long-term bisphosphonate therapy alone. Bisphosphonate was also given before or after operation to three patients.
Two patients underwent a unilateral thoracotomy for a single pulmonary lesion, and four other patients with multiple lesions underwent staged bilateral thoracotomies. The postoperative serum calcium level returned to normal after each thoracotomy in three patients who were alive and well 3, 8, and 12 years after the first thoracotomy. Hypercalcemia persisted in the other three patients. In two of the patients, bisphosphonate therapy was also unable to control hypercalcemia. In one patient the serum calcium level has been maintained in the 13 mg/dl range by bimonthly bisphosphonate therapy alone for 3 years.
The aggressive surgical approach to pulmonary metastasis of parathyroid carcinoma was shown to be effective for palliation in selected patients. Bisphosphonate therapy is an alternative to resection but has only a temporary calcium-lowering effect.
本研究的目的是对甲状旁腺癌肺转移患者进行特征分析，并评估手术和药物治疗的长期效果。
1980年至1992年间，对7例甲状旁腺癌肺转移患者进行了治疗。6例患者接受了肺转移灶切除术，1例患者仅接受了长期双膦酸盐治疗。3例患者在手术前或手术后也接受了双膦酸盐治疗。
2例患者因单个肺部病灶接受了单侧开胸手术，另外4例有多发性病灶的患者接受了分期双侧开胸手术。3例患者在首次开胸手术后3年、8年和12年存活且状况良好，每次开胸手术后血清钙水平恢复正常。另外3例患者高钙血症持续存在。其中2例患者，双膦酸盐治疗也无法控制高钙血症。1例患者仅通过每两个月一次的双膦酸盐治疗，血清钙水平维持在13mg/dl范围内达3年。
对于甲状旁腺癌肺转移，积极的手术方法对部分患者的姑息治疗有效。双膦酸盐治疗是手术切除的替代方法，但仅具有暂时降低血钙的作用。
