“七定法”診療策略在原發性甲狀旁腺功能亢進癥中的應用_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

簡衛華 , 陳真 , 馮鍵華 , 蔡文松 ,  徐波

廣州市第一人民醫院（華南理工大學附屬第二醫院）甲狀腺乳腺外科（廣州 510180）;

Corresponding?author：

徐波, Email: aabb97@163.com

Keywords：

原發性甲狀旁腺功能亢進癥; 診斷; 治療; 七定法

DOI：

10.7507/1007-9424.202604121

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

目的探討“七定法”診療流程在原發性甲狀旁腺功能亢進癥（primary hyperparathyroidism，PHPT）中的應用價值并總結單中心實踐經驗。方法回顧性分析廣州市第一人民醫院2023年11月至2025年7月期間收治的30例PHPT患者的臨床資料，構建包含定性診斷、定治療方案、定數、定位、定手術方式、定手術終點及定術后治療與隨訪方案的“七定法”診療流程，并評估其應用安全性與有效性。結果 30例PHPT患者中癥狀型18例（表現為泌尿系結石8例、骨痛6例、腹脹或心悸等高鈣相關癥狀4例），無癥狀型12例。所有患者入院時血鈣、甲狀旁腺激素（parathyroid hormone，PTH）均高于正常范圍，3例伴高鈣危象，經術前藥物預處理后血鈣降至安全范圍，均順利完成手術。所有患者均完成遺傳性腫瘤篩查，排除多發性內分泌瘤。術前定位檢查陽性率：超聲80.0%（24/30），⁹⁹Tc^m-甲氧基異丁基異腈（簡稱“MIBI”）顯像76.7%（23/30），頸部增強CT 52.9%（9/17），¹⁸F-氟代膽堿正電子發射計算機斷層成像3/3（均為經典超聲和MIBI雙定位陰性病灶）；細針穿刺洗脫液PTH檢測病灶陽性7/10。超聲與MIBI檢測結果一致性中等（Kappa=0.31）。術前預判單病灶25例、多病灶5例（多病灶共切除病變甲狀旁腺10枚）。單側靶向甲狀旁腺切除19例（其中腔鏡10例）、雙側甲狀旁腺切除術5例、同期單側甲狀旁腺切除+患側甲狀腺癌根治術6例。5例多病灶中4例行術中PTH監測，PTH均達到邁阿密標準（病灶切除10 min后PTH較基線下降≥50%）。術中冰凍及石蠟病理示甲狀旁腺腺瘤15枚、甲狀旁腺增生20枚。術后未發生聲音嘶啞、出血、切口感染等并發癥，總住院時間2~26 d、（8.9±2.1）d。術后隨訪3個月，所有患者血鈣及PTH均恢復至正常范圍。結論本組30例病例的初步臨床實踐表明，“七定法”作為PHPT診療流程符合現行指南推薦，實施過程中安全規范。由于本研究為單中心回顧性描述，樣本量小且未設立對照組，尚不能證明其優于傳統診療流程，其臨床應用價值有待后續前瞻性、大樣本、多中心對照研究進一步驗證。

Citation： 簡衛華, 陳真, 馮鍵華, 蔡文松, 徐波. “七定法”診療策略在原發性甲狀旁腺功能亢進癥中的應用. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(9): 1262-1267. doi: 10.7507/1007-9424.202604121 Copy

1.	Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism [J]. JAMA Surg, 2016, 151(10): 959-968.
2.	Roser P, Leca BM, Coelho C, et al. Diagnosis and management of parathyroid carcinoma: a state-of-the-art review [J/OL]. Endocr Relat Cancer, 2023, 30(4): e220287. doi: 10.1530/ERC-22-0287.
3.	Bilezikian JP, Khan AA, Silverberg SJ, et al. Evaluation and management of primary hyperparathyroidism: summary statement and guidelines from the Fifth International Workshop [J]. J Bone Miner Res, 2022, 37(11): 2293-2314.
4.	中華醫學會骨質疏松和骨礦鹽疾病分會, 中華醫學會內分泌分會代謝性骨病學組. 原發性甲狀旁腺功能亢進癥診療指南 [J]. 中華骨質疏松和骨礦鹽疾病雜志, 2014, 7(3): 187-198.
5.	白求恩精神研究會內分泌和糖尿病學分會介入內分泌專業委員會(學組), 中國健康促進基金會骨代謝疾病防治專項基金管委會. 原發性甲狀旁腺功能亢進熱消融治療專家共識(2021版) [J]. 中日友好醫院學報, 2021, 35(5): 259-264.
6.	周祖邦, 薛亞娥, 姚彥武, 等. 原發性甲狀旁腺功能亢進癥微波消融治療現狀與爭議 [J]. 中華超聲影像學雜志, 2022, 31(11): 1008-1011.
7.	Shah US, McCoy KL, Kelley ML, et al. How and when is multiglandular disease diagnosed in sporadic primary hyperparathyroidism? [J]. Surgery, 2022, 171(1): 35-39.
8.	Kunstman JW, Kirsch JD, Mahajan A, et al. Clinical review: parathyroid localization and implications for clinical management [J]. J Clin Endocrinol Metab, 2013, 98(3): 902-912.
9.	Rahman HA, Haque JA, Sharmin S. Sestamibi positive vs negative scan in primary hyperparathyroidism; a clinical dilemma [J]. Bangladesh J Nucl Med, 2016, 17(2): 142-145.
10.	Bergenfelz A, van Slycke S, Makay ?, et al. European multicentre study on outcome of surgery for sporadic primary hyperparathyroidism [J]. Br J Surg, 2021, 108(6): 675-683.
11.	Starker LF, Mahajan A, Bj?rklund P, et al. 4D parathyroid CT as the initial localization study for patients with de novo primary hyperparathyroidism [J]. Ann Surg Oncol, 2011, 18(6): 1723-1728.
12.	Koumakis E, Gauthé M, Martinino A, et al. FCH-PET/CT in primary hyperparathyroidism with discordant/negative MIBI scintigraphy and ultrasonography [J]. J Clin Endocrinol Metab, 2023, 108(8): 1958-1967.
13.	Liu Y, Dang Y, Huo L, et al. Preoperative localization of adenomas in primary hyperparathyroidism: the value of ¹¹C-choline PET/CT in patients with negative or discordant findings on ultrasonography and ^99mTc-sestamibi SPECT/CT [J]. J Nucl Med, 2020, 61(4): 584-589.
14.	胡亞, 花蘇榕, 王夢一, 等. 可避免的原發性甲狀旁腺功能亢進癥再次手術臨床分析 [J]. 中華外科雜志, 2017, 55(8): 577-580.
15.	代文杰, 喻慶安. 原發性甲狀旁腺功能亢進癥圍手術期處理中國專家共識(2020版) [J]. 中國實用外科雜志, 2020, 40(6): 634-638.
16.	Singh Ospina NM, Rodriguez-Gutierrez R, Maraka S, et al. Outcomes of parathyroidectomy in patients with primary hyperparathyroidism: a systematic review and meta-analysis [J]. World J Surg, 2016, 40(10): 2359-2377.
17.	徐波, 馮鍵華, 蔡文松. 原發性甲狀旁腺功能亢進癥手術治療的相關決策與處理 [J]. 臨床外科雜志, 2025, 33(3): 245-247.
18.	Irvin GL 3rd, Dembrow VD, Prudhomme DL. Clinical usefulness of an intraoperative “quick parathyroid hormone” assay [J]. Surgery, 1993, 114(6): 1019-1022.
19.	Perrier N, Lang BH, Farias LCB, et al. Surgical aspects of primary hyperparathyroidism [J]. J Bone Miner Res, 2022, 37(11): 2373-2390.
20.	Jaskowiak NT, Sugg SL, Helke J, et al. Pitfalls of intraoperative quick parathyroid hormone monitoring and gamma probe localization in surgery for primary hyperparathyroidism [J]. Arch Surg, 2002, 137(6): 659-668.

1. Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism [J]. JAMA Surg, 2016, 151(10): 959-968.
2. Roser P, Leca BM, Coelho C, et al. Diagnosis and management of parathyroid carcinoma: a state-of-the-art review [J/OL]. Endocr Relat Cancer, 2023, 30(4): e220287. doi: 10.1530/ERC-22-0287.
3. Bilezikian JP, Khan AA, Silverberg SJ, et al. Evaluation and management of primary hyperparathyroidism: summary statement and guidelines from the Fifth International Workshop [J]. J Bone Miner Res, 2022, 37(11): 2293-2314.
4. 中華醫學會骨質疏松和骨礦鹽疾病分會, 中華醫學會內分泌分會代謝性骨病學組. 原發性甲狀旁腺功能亢進癥診療指南 [J]. 中華骨質疏松和骨礦鹽疾病雜志, 2014, 7(3): 187-198.
5. 白求恩精神研究會內分泌和糖尿病學分會介入內分泌專業委員會(學組), 中國健康促進基金會骨代謝疾病防治專項基金管委會. 原發性甲狀旁腺功能亢進熱消融治療專家共識(2021版) [J]. 中日友好醫院學報, 2021, 35(5): 259-264.
6. 周祖邦, 薛亞娥, 姚彥武, 等. 原發性甲狀旁腺功能亢進癥微波消融治療現狀與爭議 [J]. 中華超聲影像學雜志, 2022, 31(11): 1008-1011.
7. Shah US, McCoy KL, Kelley ML, et al. How and when is multiglandular disease diagnosed in sporadic primary hyperparathyroidism? [J]. Surgery, 2022, 171(1): 35-39.
8. Kunstman JW, Kirsch JD, Mahajan A, et al. Clinical review: parathyroid localization and implications for clinical management [J]. J Clin Endocrinol Metab, 2013, 98(3): 902-912.
9. Rahman HA, Haque JA, Sharmin S. Sestamibi positive vs negative scan in primary hyperparathyroidism; a clinical dilemma [J]. Bangladesh J Nucl Med, 2016, 17(2): 142-145.
10. Bergenfelz A, van Slycke S, Makay ?, et al. European multicentre study on outcome of surgery for sporadic primary hyperparathyroidism [J]. Br J Surg, 2021, 108(6): 675-683.
11. Starker LF, Mahajan A, Bj?rklund P, et al. 4D parathyroid CT as the initial localization study for patients with de novo primary hyperparathyroidism [J]. Ann Surg Oncol, 2011, 18(6): 1723-1728.
12. Koumakis E, Gauthé M, Martinino A, et al. FCH-PET/CT in primary hyperparathyroidism with discordant/negative MIBI scintigraphy and ultrasonography [J]. J Clin Endocrinol Metab, 2023, 108(8): 1958-1967.
13. Liu Y, Dang Y, Huo L, et al. Preoperative localization of adenomas in primary hyperparathyroidism: the value of ¹¹C-choline PET/CT in patients with negative or discordant findings on ultrasonography and ^99mTc-sestamibi SPECT/CT [J]. J Nucl Med, 2020, 61(4): 584-589.
14. 胡亞, 花蘇榕, 王夢一, 等. 可避免的原發性甲狀旁腺功能亢進癥再次手術臨床分析 [J]. 中華外科雜志, 2017, 55(8): 577-580.
15. 代文杰, 喻慶安. 原發性甲狀旁腺功能亢進癥圍手術期處理中國專家共識(2020版) [J]. 中國實用外科雜志, 2020, 40(6): 634-638.
16. Singh Ospina NM, Rodriguez-Gutierrez R, Maraka S, et al. Outcomes of parathyroidectomy in patients with primary hyperparathyroidism: a systematic review and meta-analysis [J]. World J Surg, 2016, 40(10): 2359-2377.
17. 徐波, 馮鍵華, 蔡文松. 原發性甲狀旁腺功能亢進癥手術治療的相關決策與處理 [J]. 臨床外科雜志, 2025, 33(3): 245-247.
18. Irvin GL 3rd, Dembrow VD, Prudhomme DL. Clinical usefulness of an intraoperative “quick parathyroid hormone” assay [J]. Surgery, 1993, 114(6): 1019-1022.
19. Perrier N, Lang BH, Farias LCB, et al. Surgical aspects of primary hyperparathyroidism [J]. J Bone Miner Res, 2022, 37(11): 2373-2390.
20. Jaskowiak NT, Sugg SL, Helke J, et al. Pitfalls of intraoperative quick parathyroid hormone monitoring and gamma probe localization in surgery for primary hyperparathyroidism [J]. Arch Surg, 2002, 137(6): 659-668.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

“七定法”診療策略在原發性甲狀旁腺功能亢進癥中的應用

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content