| Objective:This study aimed to analyze the clinical characteristics,surgical diagnosis and treatment,and pathological types of primary hyperparathyroidism?PHPT?patients in Hebei General Hospital,and to follow up the surgical results.Methods:The general situation,clinical manifestations,laboratory and imaging examinations,and surgical data of 56 PHPT patients admitted to the glandular surgery department of Hebei General Hospital from September 2011to September 2019 were retrospectively analyzed,and then the postoperative recurrence was followed up.SPSS 22.0 statistical software was used to collate and analyze the data.Results:Among the 56 PHPT patients,23 were male and 33 were female,with a male to female ratio of 1:1.43 and an average age of?55.21±12.10?years.The clinical manifestations were rich and diverse,and the first diagnosis departments were widely distributed,involving 10 departments.The majority of patients first visited the department of glandular surgery and endocrinology.The misdiagnosis rate was 19.64%?11/56?in 11 cases.20 patients with asymptomatic PHPT?astomatic Primary Hyperparathyroidism,a PHPT?were hospitalized mainly because of abnormalities found in physical examination?examination of blood calcium and neck color doppler ultrasound?and thyroid disease;36 cases of symptomatic PHPT?s PHPT?patients,most of which were merged with multiple system damage performance,mostly with symptoms of skeletal system.Serum calcium,phosphorus,parathyroid hormone?PTH?,creatinine,uric acid and other biochemical abnormalities in s PHPT patients were more serious than a PHPT patients.Fifty-three patients underwent the first parathyroid surgery,the positive rates of neck ultrasound,99mTc-Methoxyisobutylisonitrile(99mTc-MIBI)single photon emission computed tomography?SPECT/CT?,ultrasound combined 99mTc-MIBI SPECT/CT and neck computed tomography?CT?were 67.92%,95.56%,97.78%and 35.29%,respectively.Bone mineral density examination was performed in 26 PHPT patients.The proportion of osteoporosis was relatively high?88.46%,23/26?.PTH,serum calcium and alkaline phosphatase?ALP?were all decreased,but serum phosphorus was increased on the first day after operation than preoperative of fifty-three patients underwent surgery?P<0.05?.Postoperative pathology revealed 40 cases of parathyroid adenoma,6 cases of hyperplasia,3 cases of cyst,1 case of atypical adenoma and 3 cases of adenocarcinoma.There were 38 patients with thyroid disease,among which29 were benign?76.32%?and 9 were malignant?23.68%?.Postoperative complications were mostly transient hypocalcemia,which returned to normal after calcium supplementation.A total of 48 patients were followed up.Their blood calcium,blood phosphorus and PTH all returned to normal levels after surgery,without new urinary stones or pathological fractures.There was no recurrence or metastasis in 3 patients with parathyroid carcinoma at the first diagnosis in our hospital.The cure rate of the first operation was 100%.Pearson correlation analysis:preoperative serum calcium was positively correlated with serum PTH,ALP,the diseased parathyroid size,urea,uric acid,creatinine,triglycerides?TG?and Fasting Glucose?FBG??P<0.05?;PTH was positively correlated with serum calcium,ALP,uric acid,and the diseased parathyroid size?P<0.05?.ALP was positively correlated with serum calcium,PTH and uric acid?P<0.05?.The diseased parathyroid size was positively correlated with serum calcium and PTH?P<0.05?.Serum calcium,PTH,ALP and the diseased parathyroid size were negatively correlated with serum phosphorus?P<0.05?.Conclusions:1.The first diagnosis departments of PHPT patients are widely distributed,also the clinical manifestations are rich and varied,so it is easy to be misdiagnosed.The general examination of blood calcium and neck ultrasound can improve the diagnosis of a PHPT.2.SPHPT is mainly present in our hospital,most of which are complicated with multiple system damage manifestations,and the number of patients with skeletal system symptoms is the largest.The degree of biochemical abnormality of s PHPT is more serious than that of a PHPT.3.The preoperative 99mTc-MIBI SPECT/CT scan is more accurate than the ultrasound in the neck,in addition the combined examination of them can improve the positioning accuracy.Bone mineral density has not been widely used in PHPT patients in our hospital and it should be concerned by clinicians.4.Serum calcium was positively correlated with PTH,ALP,the diseased parathyroid size,urea,uric acid,creatinine,TG and FBG.PTH was positively correlated with ALP,uric acid and the diseased parathyroid size.ALP is positively correlated with uric acid.Serum calcium,PTH,ALP and the diseased parathyroid size were negatively correlated with serum phosphorus.5.Surgery is an effective treatment for PHPT.After the operation symptoms and biochemical indicators are both improved. |
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