A clinical study on primary hyperparathyroidism--indication of operation and surgical technique

PHPTは1980年以降急増した.臨床型は結石型33例, 骨型, 混合型12例, 化学型7例であった.病理組織像では49例が単一腺腫, 3例が過形成であった.腺腫例は全例術後の高Ca血症は軽快したが, 過形成は2例が軽快しなかった.画像診断の普及した1980年以降は腺腫の36/39例は局在診断が可能で, 正診率はCT 29例が最高であった.手術適応は化学型にも有り得, 腺腫の局在が診断された症例は小切開, 腺腫摘除の縮小手術も考慮される
Fifty-two cases of primary hyperparathyroidism were experienced at Kyoto University Hospital and affiliated hospitals between 1965 and 1990. Thirty-three of them (63%) were of the stone type, twelve (23%) of the bone or mixed type, seven (13%) of the chemical type. Histopathological findings showed adenoma in 49 cases and hyperplasia in 3 cases. Serum calcium levels decreased postoperatively in all cases of adenoma but unchanged in 2 of 3 cases of hyperplasia. For parathyroid adenoma, the accuracy of localization was more than 90% by the combination of computed tomography, magnetic resonance imaging, ultrasonography, subtraction scintigraphy with 201TI and 123I, venous sampling for parathyroid hormone and/or angiography. Simple removal of parathyroid adenoma may be recommended in a case of primary hyperparathyroidism due to a single adenoma which was revealed by preoperative image diagnosis.