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目的总结5例甲状旁腺癌(PTC)的诊治经验。方法回顾性分析5例PTC患者的临床资料。结果 5例均有原发性甲状旁腺功能亢进症的表现,4例有高钙血症,3例血甲状旁腺素(PTH)升高达正常上限的2倍以上。5例均经常规病理及免疫组化确诊。1例行甲状旁腺切除术+患侧甲状腺全切除术+Ⅵ区淋巴清扫术,4例行甲状旁腺肿瘤残留灶切除+患侧甲状腺全切除术+同侧颈淋巴清扫术(Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ区)。随访1-7年,4例复发。2例PTC伴多发性骨转移和颈淋巴结转移及1例PTC伴颈淋巴结转移患者,术后再次手术行颈部淋巴清扫并颈部放射治疗;1例PTC伴颈淋巴结转移患者,术后再次手术行颈部淋巴清扫并颈部放射治疗,2年后发现肺部转移,行γ刀治疗。结论术前血钙、PTH、超声和CT检查有利于明确PTC诊断。手术方式以甲状旁腺切除术+患侧甲状腺全切除术+同侧颈淋巴清扫术为宜。
Objective To summarize the diagnosis and treatment of 5 cases of parathyroid carcinoma (PTC). Methods The clinical data of 5 PTC patients were retrospectively analyzed. Results All 5 patients had primary hyperparathyroidism, 4 had hypercalcemia, and 3 had parathyroid hormone (PTH) increased more than twice as much as the upper limit of normal. 5 cases were routine pathological and immunohistochemical diagnosis. 1 case of parathyroidectomy + ipsilateral total thyroidectomy + Ⅵ lymph node dissection, 4 cases of parathyroid tumor residual tumor resection + ipsilateral thyroidectomy + ipsilateral neck dissection (Ⅱ, Ⅲ , Ⅳ, Ⅴ, Ⅵ area). Follow-up 1-7 years, 4 cases of recurrence. Two cases of PTC with multiple bone metastases and cervical lymph node metastases and one case of PTC with cervical lymph node metastases were treated with neck lymph node dissection and neck radiotherapy after operation. One patient with PTC and cervical lymph node metastasis was operated again Neck lymphadenectomy and neck radiotherapy, 2 years after the discovery of lung metastases, gamma knife treatment. Conclusions Preoperative serum calcium, PTH, ultrasound and CT examination are helpful to confirm the diagnosis of PTC. Surgery to parathyroidectomy + ipsilateral thyroidectomy + ipsilateral neck dissection is appropriate.