Surgical Diagnosis And Treatment Of 52 Cases Of Primary Hyperparathyroidism

Objective:To investigate the surgical diagnosis and treatment of primary hyperparathyroidism.Methods:The clinical data of 52 patients with pathologically confirmed primary hyperparathyroidism admitted to ShanXi DaYi hospital?ShanXi Academy of Medical sciences?from January 2012 to December 2018 were retrospectively analyzed to explore their experience in surgical diagnosis and treatment.Results:1.The diagnosis of primary hyperparathyroidism mainly depends on its clinical manifestations,laboratory examination that is qualitative examination,imaging examination that is localization examination,while the treatment mainly depends on different surgical resection methods according to different pathological types,and the curative effect is reliable.2.Patients with primary hyperparathyroidism can be divided into asymptomatic and asymptomatic types.Among them,the clinical manifestations of symptomatic patients are diverse,mainly manifested in three aspects:skeletal system disease,urinary system disease and hypercalcemia syndrome,which can occur alone or exist in combination.Among them,skeletal diseases are mainly manifested as pain of bone and joint,accompanied by obvious tenderness,and pathological fracture and bone deformity may occur gradually.The main manifestations of urinary system diseases are polydipsia,polydipsia,and polyuria.Urinary stones may occur repeatedly,which are manifested as renal colic,urinary tract infection,hematuria,and even renal failure.Hypercalcemia syndrome is caused by increased calcium in the blood,which can affect many systems,often manifested as fatigue,fatigue,appetite loss,abdominal distension,nausea,vomiting,constipation,gastroduodenal ulcer,pancreatitis,etc.In this study,there were 43 patients?82.7%?with symptomatic primary hyperparathyroidism and 9 patients?17.3%?with asymptomatic hyperparathyroidism,and the misdiagnosis rate of this disease was high,reaching 67.3%?35/52?in this study.3.The qualitative diagnosis of primary hyperparathyroidism mainly depends on the examination of blood calcium,blood phosphorus and blood parathyroid hormone.In this study,all the 52 patients with primary hyperparathyroidism underwent preoperative examination of serum calcium,serum phosphorus and serum parathyroid hormone,among which the preoperative serum calcium was 635.5 621.3pg/ml,the preoperative serum calcium was 3.04 0.51mmol/L,and the preoperative serum phosphorus was 0.760.32mmol/L.It can be seen that the serum calcium and serum parathyroid hormone in most PHPT patients were significantly higher than the normal range,while the serum phosphorus was lower than the normal range.Meanwhile,in this study,all the 52 patients with primary hyperparathyroidism underwent serum calcium and serum parathyroid hormone reexamination on the first day after surgery,and the serum calcium was 63.529.2 pg/ml on the first day after surgery,and 2.23 0.34mmol/L on the first day after surgery,indicating that the postoperative serum calcium was significantly decreased,and the change of serum calcium was not obvious.4.Primary hyperparathyroidism is diagnosed using three modalities,including thyroid and neck color doppler ultrasound,thyroid CT and 99mtc-99mtc-mibi SPECT/CT.In the study of 52 patients with primary parathyroid function already preoperative thyroid and cervical colour to exceed examination,positive rate was 76.9%?40/52?examination,27 patients with primary parathyroid function already preoperative thyroid CT examination,positive rate was 74.1%?20/27?examination,27 patients with primary parathyroid function already preoperative line 99mTc technetium-methoxy isobutyl different nitrile(^99mTc-MIBI)SPECT/CT examination,positive detection rate was 96.3%?26/27?.5.Primary hyperparathyroidism is mainly treated by surgical operation,and different surgical methods and surgical resection range are adopted according to different pathological types.In this study,52 patients with primary hyperparathyroidism underwentsurgical treatment,with a 100%success rate.Among them,42 cases?80.7%?of parathyroid adenoma,4 cases?7.8%?of parathyroid hyperplasia,and 6 cases?11.5%?of parathyroid carcinoma were confirmed by pathology.Postoperative 20 cases?38.5%?of PHPT patients showed perioral and limb numbness,and 2 cases?3.8%?showed pharyngeal pain and discomfort.Conclusion:In China,patients with primary hyperparathyroidism are more common in symptomatic types and have a high rate of misdiagnosis.Qualitative diagnosis is mainly based on increased serum parathyroid hormone and calcium concentration,while localized diagnosis is mainly based on color doppler ultrasound,CT and radionuclide imaging.Surgery is the safest and most effective way to treat patients with primary hyperparathyroidism.