Objective: To introduce the advanced diagnostic technologies and share the surgical experience of parathyroid adenoma.
Methods: From November 1986 to August 2000, 9 patients with parathyroid adenoma who underwent operations were analyzed retrospectively. Out of them, there were 3 males and 6 females and their ages ranged from 12 to 55 years with an average of 32 years. The average disease course was 4 years and 9 months. General decreased density of the bone cortex and subperiosteum absorption were found in all 9 cases, while multi bone cyst lesion in 3 cases; obsolete fracture in 5 cases, including 2 cases of nephrolithiasis. Before operation, one child bore claudication and the other 8 patients suffered from disability. Serum parathyroid hormone (PTH) level increased markedly in 5 patients examined (633.87-1,017.40 pmol/L, normal value: 28.50-90.50 pmol/L). Radionuclide scan showed that imagings of parathyroid adenoma appeared in 3 patients.
Results: Parathyroid adenoma was resected via neck approach in 7 cases, and by way of sternum in the other 2 of the adenomas located in the chest. Parathyroid adenoma was diagnosed pathologically in 9 cases. All the 9 patients had no relapse during the 2-16 years of follow-up, with apparent relief of ostealgia and the normal serum PTH level, and roentgenogram showed fracture healing, great alleviation of the osteopathia.
Conclusion: PTH examination as an advanced technique plays an important role in the differential diagnosis of hypercalcaemia. Color Doppler and radionuclide scan can locate the lesion. It is vital to judge the nature of the lesion by naked eyes, while frozen slices serves as a necessity to confirm. Enough parathyroid tissue should to be remained to assure normal parathyroid function. The variable number and ectopic possibility of parathyroid glands should be considered. Both the short-term and long-term surgical outcome of parathyroid adenoma are satisfactory.