原発性上皮小体機能亢進症 : 手術適応と手術手技における諸問題

Abstract

1959年より1990年10月までに手術を行ったPHPT 307例を対象とした.1)無症候性の化学型PHPTの頻度は近年明らかに増加傾向にある.また, 結石形成, 骨病変, 悪性腫瘍等の合併症を考慮すると, 現時点では化学型を含めたすべてのPHPTの症例に対し, 手術適応があるものと考えられる.2)手術手技において, 異所性を除く単発腺腫に対しては, 片側の2腺の手術にとどめることにより手術合併症をかなり減少させうるが, CT, 超音波断層像による最近の術前部位診断率から推測すると, 正常部位にある単発腺腫の89%, 全症例の76%が片側手術により治癒可能であると推測された

Between 1959 and Oct. 1990, 307 cases of primary hyperparathyroidism (PHPT) were operated on in our hospital. Among them, 23 cases (7.5%) were asymptomatic chemical type of PHPT, and the incidence of this type has been increasing these days. Various symptoms or signs including urolithiasis, bone disease, cardiovascular disease, gastrointestinal disease, diabetes mellitus and others were associated with PHPT. Especially, as a lethal factor, malignant tumors developed in 14 cases (4.6%); 9 cases of non-medullary thyroid cancer and tumors of other organs. In consideration of these associated disorders, the chemical type of PHPT should be operated prophylactically. In order to reduce operative complications, unilateral exploration is available for the cases of single normally localized adenoma; 85.7% of our 307 cases. Moreover, the positive rate of preoperative localized test by CT and ultrasonography for such adenomas is 78% in the recent 5 years. The predictive values of successful operation by unilateral exploration are 89% in the cases of normally localized single adenoma and 76% in all PHPT.