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投稿时间：2025-05-13 网络发布日期：2026-03-04
投稿时间：2025-05-13 网络发布日期：2026-03-04
中文摘要: 目的 探讨继发性甲状旁腺功能亢进（SHPT）患者甲状旁腺切除术（PTX）后合并纵隔异位甲状旁腺的临床特征。方法 2016年8月至2024年11月连续在中日友好医院因SHPT进行PTX的321例患者中，5例患者首次PTX手术后发现纵隔异位甲状旁腺，占1.6%，分析这5例患者的临床资料特点。结果 5例纵隔异位甲状旁腺患者均为男性，年龄（44.0±5.9）岁，身体质量指数（BMI）（29.6±4.7）kg/m2，首次手术前血清甲状旁腺激素（PTH）水平为（2 753.0±612.2）pg/mL，血钙（2.6±0.3）mmol/L，血磷（2.3±0.8）mmol/L，碱性磷酸酶（467.2±197.0）u/L，首次手术后PTH（2 599.0±796.7）pg/mL，血钙（2.3±0.1）mmol/L，血磷（2.0±0.6）mmol/L，碱性磷酸酶（480.0±202.7）u/L。首次术前超声及CT检查未提示纵隔异位，术后核素计算机断层扫描显示存在纵隔异位甲状旁腺。3例患者进行了二次手术，分别进行了颈部开放式手术和胸腔镜手术，术后PTH水平恢复正常，无并发症发生。2例未再行手术治疗，采取了西那卡塞、骨化三醇等药物治疗。结论 SHPT患者PTX术后纵隔异位甲状旁腺发生率约为1.6%，男性多见，BMI升高达肥胖标准，患者术前PTH明显升高、术前血钙高于正常水平。CT阅片经验的增强有助于提高诊断率，核素断层扫描具有一定的诊断意义。二次补充手术可以达到满意的疗效。
Abstract:Objective To investigate the clinical characteristics of mediastinal ectopic parathyroid glands complicated after parathyroidectomy（PTX）in patients with secondary hyperparathyroidism（SHPT）. Methods From August 2016 to November 2024，among 321 patients who underwent PTX due to SHPT in China-Japan Friendship Hospital consecutively，5 patients were found mediastinal ectopic parathyroid gland after the first PTX，accounting for 1.6%.The clinical data characteristics of these 5 patients were analyzed. Results Five patients with ectopic parathyroid in mediastinum were all male，with an age of（44.0±5.9）years，a body mass index（BMI）of（29.6±4.7）kg/m2；and the levels before first surgery included serum parathyroid hormone（PTH）level of（2 753±612.20）pg/mL，blood calcium level of（2.6±0.3）mmol/L，bloodphosphoruslevel of（2.3±0.8）mmol/L，and alkalinephosphataselevel of（467.2±197.0）u/L；while the levels after first surgery included PTH level of（2 599.0±796.7）pg/mL，blood calcium level of （2.3±0.1）mmol/L，blood phosphorus level of（2.0±0.6）mmol/L，and alkaline phosphatase level of（480±202.70）u/L. Ultrasound and CT examination did not indicate mediastinal ectopic parathyroids before the first operation，but radionuclide computed tomography showed the presence of mediastinal ectopic parathyroids after the first surgery. Three of the patients underwent secondary surgery，including open neck surgery and thoracoscopic surgery，respectively，and the PTH levels returned to normal after operation without complications. Two cases did not undergo further surgical treatment and were treated with drugs such as cinacalcet and calcitriol. Conclusion The incidence of ectopic parathyroid glands in the mediastinum after PTX in SHPT patients is approximately 1.6%，with a higher prevalence in males. Patients often meet the criteria for obesity based on their BMI，and there is a significant increase in preoperative PTH levels，along with preoperative serum calcium levels exceeding the normal range. Enhanced CT reading experience helps to improve the diagnosis rate，and radionuclide tomography has a certain diagnostic significance. Spplementary surgery can achieve satisfactory results.
keywords: Hyperparathyroidism, secondary Parathyroid gland Clinical Ectopic mediastinal characteristics Reoperation Parathyroidectomy
文章编号： 中图分类号：R582 R605 文献标志码：A
基金项目:中央高水平医院临床科研业务费资助（2023-NHLHCRF-YYPPLC-ZR-08）
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引用文本：
马嘉宜,李子健,李淳钰,等.继发性甲状旁腺功能亢进手术后合并纵隔异位甲状旁腺5例临床分析[J].中国临床研究,2026,39(2):243-246,256.
马嘉宜,李子健,李淳钰,等.继发性甲状旁腺功能亢进手术后合并纵隔异位甲状旁腺5例临床分析[J].中国临床研究,2026,39(2):243-246,256.