目的    总结以胰腺炎为首发症状的甲状旁腺功能亢进（PHPT）病人的临床特点及诊治经验。方法    回顾性分析2009年2月至2013年3月中国医科大学附属第一医院普通外科收治的6例以胰腺炎为首发症状的PHPT病人的临床资料，探讨该部分病人的诊断和治疗策略。结果    6例病人中有4例并发急性胰腺炎，2例并发慢性胰腺炎。4例急性胰腺炎病人起病急、进展快，血钙均>3.5 mmol/L并出现典型的高钙危象症状，3例病人行手术切除病变甲状旁腺腺瘤，2例痊愈，1例死于药物性肝功能衰竭，另1例病人未行手术治疗，因高钙血症死亡。2例慢性胰腺炎病人临床症状较轻，均伴有胰管内结石，尽管血钙>3.5 mmol/L但未出现高钙危象的临床表现，手术治疗后胰腺炎痊愈，其中1例随访中胰腺炎出现反复发作，1例无复发。结论    当胰腺炎未发现其常见病因而又存在血钙正常或异常升高时，应警惕PHPT所致胰腺炎。通过定性定位诊断后，及时外科手术治疗PHPT可缓解胰腺炎病情、提高病人存活率。

Diagnosis and treatment of the pancreatitis as an initial manifestation of primary hyperparathyroidism：             A report of 6 cases        HE Liang*, ZHANG Hao, ZHANG Ping, et al. *Department of General Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
Corresponding author: ZHANG Hao，E-mail: haozhang@mail.cmu.edu.cn
Abstract    Objective    To evaluate the clinical characteristics, diagnosis and treatment of the pancreatitis as an initial manifestation of primary hyperparathyroidism (PHPT). Methods    The clinical data of 6 cases of the pancreatitis as an initial manifestation of PHPT admitted from February 2009 to March 2013 in Department of General Surgery, the First Hospital of China Medical University were reviewed retrospectively for the diagnosis and treatment strategies. Results   Of 6 patients with PHPT, 4 patients complicated with acute pancreatitis and 2 patients complicated with chronic pancreatitis. Four patients with acute pancreatitis presented rapid progression. The serum calcium concentration was higher than 3.5mmol/L and the typical hypercalcemia crisis appeared in 4 patients. Resection of parathyroid adenoma was performed in 3 patients. Two patients were cured and 1 died of drug-induced liver failure. The other one without operation died of hypercalcemia crisis. Two chronic pancreatitis patients with pancreatolithiasis showed mild symptoms. Although the serum calcium concentration was higher than 3.5mmol/L, no hypercalcemia crisis appeared. They were cured after the resection of parathyroid adenoma. One of them presented recurrent pancreatitis during the follow-up period and one patient had no recurrence. Conclusion    PHPT should be suspected highly when pancreatitis appeared without common causes, especially combined with normal or elevated serum calcium concentration. Surgery is considered as the most direct and effective way to treat PHPT and could alleviate the symptom of pancreatitis and improve survival rate.