頁籤選單縮合
題 名 | 外科醫師在原發副甲腺高能症術中病理診斷的角色 |
---|---|
作 者 | 龔松保; 李建賢; 王惠暢; 彭芳谷; 雷永耀; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 26:4 民82.07-08 |
頁 次 | 頁1891-1896 |
分類號 | 416.214 |
關鍵詞 | 原發副甲腺高能症; 術中病理診斷; 外科醫師的角色; Primary hyperparathyroidism; Perioperative pathologic diagnosis; Surgeon's role; |
語 文 | 中文(Chinese) |
中文摘要 | 從1969到1987年,73位原發副甲腺高能症手術後至少追踪4年以上的病人,術中病理診斷腺瘤有49人,腺體增生22人,腺癌1人,正常1人;手術僅切除唯一增大的腺體有54位,3-4個腺體增大並施予次全切除者18位,為腺癌施整個擴大切除者1 位。1位MEN-I病人切除唯一增大體後,病理診斷為腺瘤,因而未切取其他外表正常的腺體,術後仍呈高血鈣。5位術中發現各只有1個增大腺體,將之切除送檢的冰凍病理4位是腺體增生,1位正常,其他腺體因明顯正常而未繼續切除,術後卻從原有高血鈣恢復並維持正常血鈣至少已有7年之久。回顧術中病理診斷的困擾,主要是因為切取標本非典型病變區,或病變本身界線不明又未能再切取足夠的典型標本。為求完美,手術時外科醫師應謹慎負責,當冰凍病理與肉眼所見不相配合時可協同病理專家並做可能的進一步追查,再不然術者的合邏輯判斷也可增加手術治癒率。 |
英文摘要 | From 1969 to 1987, 73 patients with l° HPT, treated surgically, had been also followed up for at least four years in this hospital. The POPDs included adenoma, 49 patients; hyperplasia, 22; carcinoma, 1 and normal, 1.The surgeon had found and excised 1 solitary enlarged gland in 54 patients, 2 1/2 -3 1/2 of the 3-4 enlarged glands in 18 and a carcinoma by en-bloc resection in 1. One solitary enlarged gland in a patient with MEN-I was mistaken for adenoma, which led to a single excision; hypercalcemia persisted post-operatively. Four patients with a pathologic diagnosis of parathyroid hyperplasia and one with normal parathyroid were operated by excision of a grossly enlarged solitary gland, according to the surgeon's judgement. These patients showed eucalcemia for more than seven years. Reviewing of the POPDs found that their possible problems were primarily a result of unclear pathological criteria and/or inadequate specimens. Thus surgeons should remove as much material for pathological specimens as possible if the POPD does not correlate with observed gross features. Sometimes POPD for 1° HPT may not be necessarily correct, and the surgeon's operative findings are important to improve the accuracy of treatment. |
本系統中英文摘要資訊取自各篇刊載內容。