Abstract:

Diagnosis and treatment of hyperparathyroid crisis: An analysis of 19 patients        WU Yi-dan, YU Liang, LI Xiao-xi. Department of Breast and Thyroid Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
Corresponding author: LI Xiao-xi, E-mail: lix2@21cn.com
Abstract    Objective    To explore the diagnostic and therapeutic method of hyperparathyroid crisis. Methods    A total of 19 patients who were diagnosed hyperparathyroid crisis and undergone parathyroidectomies were enrolled between January 2003 and February 2016 in the First Affiliated Hospital of Sun Yat-sen University. Their clinical data were analyzed retrospectively. Results    All the 19 patients received preoperative localization. The accuracy of ultrasound， radionuclide imaging and CT were 87.5%（14/16）， 100.0%（16/16） and 85.7%（6/7）. Ultrasound plus radionuclide imaging was the most frequent combination method（8/19，42.1%）， with the accuracy up to 100.0%（8/8）. Fourteen patients received preoperative medical management in order to reduce serum calcium. The average serum calcium level before， after preoperative medical management， and after surgery were （3.8±0.3）mmol/L，（3.4±0.6）mmol/L and （2.0±0.4）mmol/L respectively， which showed that the surgery could provide superior effect in reducing the serum calcium concentration over preoperative medical management （t=2.893，P=0.013）. Although 47.4% and 73.7% of patients’ serum calcium level were still over 3.75mmol/L and 3.50mmol/L， most of them tolerated surgery safely，except one patient died from multiple organ failure. Conclusion    Surgery is a basic and effective therapy to cure hyperparathyroid crisis， which is better than internal medical treatment. The preparing time and the level of serum calcium before surgery are not related to the risk of surgery.

Key words: hyperparathyroid crisis, hypercalcemia, parathyroidectomy

摘要：

目的    探讨甲状旁腺危象的治疗方法。方法    回顾性分析自2003年1月至2016年2月于中山大学附属第一医院诊断并行手术治疗的19例甲状旁腺危象病人的临床资料。结果    19例病人术前均行定位检查，准确率为：超声87.5%（14/16），核素显像100.0%（16/16），CT 85.7%（6/7），最常用的联合检查为超声联合核素显像（8/19，42.1%），准确率达100.0%（8/8）。14例病人术前行非手术降钙治疗，治疗前平均血钙水平为（3.8±0.3）mmol/L，至术前为（3.4±0.6）mmol/L，术后为（2.0±0.4）mmol/L。手术治疗能显著降低病人血钙，效果优于非手术治疗（t=2.893，P=0.013）。9例（47.4%）病人术前血钙仍＞3.75 mmol/L，14例（73.7%）病人术前血钙＞3.50 mmol/L，仅1例病人因术后甲状旁腺危象引起的全身器官功能障碍死亡。结论    手术是甲状旁腺危象有效的治疗方法，术前准备目的是明确定性及定位诊断，不应片面追求降低术前血钙水平，以免延误手术时机。

关键词: 甲状旁腺危象, 高钙血症, 甲状旁腺切除术