原发性巨大甲状旁腺瘤28例临床特征分析并文献复习OA

Objective To analyze the clinical characteristics of primary giant parathyroid adenoma(GPTA)and compare them with data from the international literature,thereby providing evidence for clinical diagnosis and treatment.Methods Clinical data of 28 patients who met the volumetric criteria for GPTA and were treated in the Department of General Surgery and Department of Otolaryngology Head and Neck Surgery,the First Medical Center of Chinese PLA General Hospital from January 2009 to December 2024 were retrospectively analyzed.Preoperative and postoperative biochemical markers,including serum calcium and parathyroid hormone(PTH),were detected and compared.Preoperative imaging was performed to determine the location and extent of the lesions.All patients underwent minimally invasive parathyroidectomy,and the diagnosis was confirmed by intraoperative frozen section and postoperative pathological examination.Relevant English-language literature was retrieved from databases such as PubMed,and data from 25 GPTA cases reported in 23 studies were collected for comparative analysis with our cohort.Results The 28 patients in our cohort comprised 14 males and 14 females,with a mean age of 54.1 years and a mean disease duration of 15.9 months;75.0%were symptomatic.Postoperative serum calcium and PTH levels decreased significantly compared with preoperative values(calcium:2.23 mmol/L vs.3.19 mmol/L;PTH:18.51 pg/ml vs.1091.0 pg/ml,P<0.001).No significant correlation was found between preoperative serum calcium or PTH levels and tumor volume or weight(P>0.05).No ectopic lesions were identified.The postoperative complication rate was 32.1%.Among the 25 foreign cases,the male-to-female ratio was 1:2.13,and the mean age was 47.9 years.The preoperative serum calcium and PTH levels were 4.71 mmol/L and 1291.42 pg/ml,respectively.A positive correlation between tumor volume and weight was observed in 16 cases(P<0.001).The ectopic lesion rate was 32.0%,and the postoperative complication rate was 52.0%.Conclusions Primary GPTA lacks specific clinical symptoms,and elevated serum calcium and PTH levels are its characteristic markers.Surgery is the only curative treatment with a favorable prognosis.Significant differences exist between our cohort and the foreign GPTA cases in terms of gender ratio,age,incidence of ectopic lesions and postoperative complication rate.