The old lady relapses bellyacke vomits 2 years, helping abdomen up to ask doctor, gram size " nodal

# cool breeze plans ## to exceed daily medical service of ## of can healthy group to talk about #

It is the outpatient service of expert of armour of breast of hospital of beneficial in relief downtown Director Chen Zhou every week, an old grandma of 68 years old is helping abdomen up, depressed the ground appeals to Director Chen: "Director, I is this what disease after all? I is this what disease after all??

Director Chen is helping A mother-in-law up to sit down, original grandma appears nearly 2 years repeatedly " bone of bellyacke, vomiting, flesh is aching, at the same time companion has uric stone " , the grandma sees a doctor repeatedly in local hospital, all had disappeared to turn.

Convention is diagnosed cannot very good explanation these clinical expression, have an attention that caused Director Chen as a result unusually, it is hematic calcic 2.81moml/l, is it possible that does the gland other armour shape have a problem?

Exceed an examination through thyroid colour, go up in the left thyroid gland of the grandma as expected extremely rear discovery finish section, it is this not as good as of gram size " nodal " , tormented a grandma full two years.

(the bump that the operation excises)

Director Chen arranges a grandma quickly to be admitted to hospital, hormone of the gland other perfect armour shape, calcic phosphor determines scanning of nuclide of the gland other the shape that reach armour, cervical CT,

At complete hemp be issued to lower levels resection of the adenoma other Zun Shangjia shape (PTH test paper is used to be the gland other armour shape certainly in art) , get effect instantly of the effect after art, value of value of hematic calcic phosphor, the gland other armour shape falls basically it is normal to come, the symptom alleviates and leave hospital smoothly.

This is extremely the disease of fallibility examine, clinical expression and kitchen of the primary affection decide hard, and surgical operation is the most effective treatment method.

One of human body endocrine.

Human body has the gland other shape of two pairs of armour (about 62% ) , palm yellow, soja of be similar in shape, be located in the reverse side of thyroid gland of or so two leaves respectively (or bury amid) mid with bottom.

Main function is secrete hormone of the gland other armour shape (abbreviation PTH) , adjust the metabolization of the calcium inside airframe, phosphor. Function of the gland other armour shape low or hyperfunction all can cause a series of diseases.

1, former hair sex

Disease of hyperfunction of function of the gland other shape of the former armour that send a gender (Primary Hyperparathyroidism, PHPT) abbreviation sends the excessive other armour formerly, the primary affection of organization of the gland other the shape that fasten armour changes hormone of the gland other the shape that cause nail (Parathyroid Hormone, PTH) is secreted overmuch.

A group of when bring about thereby clinical disease group, include disease of tall calcic blood, kidney calcium is absorbed again and uric phosphor is excreted increase, calcium of kidney stone, kidney pledges ad cool-headed disease is mixed give priority to bone to absorb with coriaceous bone increase etc.

Pathology with adenoma of the gland other individual armour shape the commonnest, minority is cancer of the gland other hyperplasia of the gland other armour shape or armour shape.

2, afterwards sends a gender

Disease of hyperfunction of function of the gland other shape of armour of afterwards hair sex (Secondary Hyperparathyroidism, SHPT) abbreviation afterwards sends the excessive other sexual armour.

The disease of low calcic blood that often causes for all sorts of reasons stimulates hyperplasia of the gland other armour shape corpulent, secrete overmuch PTH be caused by.

See nephrosis of Yu Man sex, osteomalacia disease, bowel is absorbed undesirable and integrated proof, vitamin D lack and hydroxide die the disease such as the obstacle.

3, 3 hair sex

Disease of hyperfunction of function of the gland other shape of armour of 3 hair sex (Tertiary Hyperparathyroidism) abbreviation the excessive other armour of 3 hair sex, it is to be in by armour of afterwards hair sex on excessive foundation, get as a result of gland body abiding stimulation, development is the hyperplasia with own function or tumour, secrete overmuch PTH be caused by independently, after nephrosis of sex of common Yu Man and kidney transplant.

(test paper of the gland other armour shape, delegate of two red thick line determines to be organized for the gland other armour shape)

(detector of hormone of the gland other armour shape)

Basically have 3 groups of symptoms such as tall blood calcium, skeletal pathological changes and urology.

Can appear alone or close to exist, general progress is slow, invariable month or several years of ability cause the patient's attention and see a doctor.

1, the symptom of disease of tall calcic blood

The symptom that place of heighten of hematic calcic level causes can affect many systems.

① central nervous system:

Intellective and change of dim, dejected, disposition, slow, memory drops, the symptom such as be agitated.

System of ② nerve muscle:

Muscle of easy exhaustion, limb is weak, carry muscle blame nearly very, the person that weigh produces sweeny. Can accompany report having flesh to pursue unusual.

Weakness of this kind of muscle and atrophy are by armour after excessive operation is treated, can obtain correct.

③ digestion:

Common inappetence, abdominal distension, constipation, serious disease of tall calcic blood can have disgusting vomiting, instead acerbity, on bellyacke.

Ionic Yi Chen wears ④ calcium to be mixed at the pancreas of alkalescent pancreatic juice is in charge of inside pancreas, activation trypsin is mixed formerly trypsin, about 5% right-and-left patients have acute or chronic pancreatitis show effect.

Clinical it is important to get on a when chronic pancreatitis is the excessive other the former armour that send a gender diagnostic clew.

Value of calcium of the blood when general pancreatitis is reduced, if patient blood is calcic the value is normal or heighten, should except sends the excessive other sexual armour formerly.

2, skeletal pathological changes

Typical pathological changes is comprehensive framework bone of sex of bursa of sex of missing, fiber brown tumour forms phlogistic, cyst, pathology sex fracture and bone are unbalanced.

Main show aches for extensive bone joint, accompany apparent tenderness.

The case that home reports 80% with skeletal pathological changes expression is given priority to or exist at the same time with urology stone.

3, urology symptom

The physiology action of PTH is the calcic heavy absorptivity in increasing canaliculus of kidney far music, absorb of the phosphor in restraining kidney to reach far music canaliculus nearly again.

The patient can produce iteration kidney or ureter stone, expression is the symptom of kidney angina or ureter convulsion, arenaceous stone of make water of blood in the urine, milky white or make water, also can have kidney calcic salt ad cool-headed disease.

Every has make water of skeletal pathological changes, secrete is the clinical expression of stone and disease of tall calcic blood, alone existence or 3 two sign are compound when coexisting, hematic calcium, alkalescent phosphoric acid is enzymatic with phosphor of PTH heighten, blood the value is reduced, uric calcium discharges volume increase.

Bone X line has bone to absorb addition diagnostic sex performance to all support the diagnosis of the excessive other armour.

1, cure

Patient of the excessive other the former armour sending a gender that have a symptom or has complication answers operation cure.

Majority of the excessive other the former armour that send a gender is adenoma, it is 1 mostly, minority shows 2 or 2 above. A few patient is the gland other 4 armour shape all proliferous hypertrophy.

Accordingly, no matter,be in in the operation tumor or hyperplasia, all should probe the gland other all armour shape, if be adenoma, do adenoma to excise.

If be hyperplasia, advocate excision 3+1/2 gland body, also have the method that uses 4 gland body to be excised entirely.

Take fraction to do the gland other armour shape to transplant from body next, bury is in muscle.

If be gland cancer, criterion appropriate is done effect a radical cure art.

The successful rate of cervical operation amounts to the surgeon first time that has experience commonly 90% above.

The operation is omited, different of the gland other the armour shape of pathological changes, the gland other proliferous armour shape excises inadequacy or recrudesce is made an appointment with 10% , need a consideration again operation, answer to review record of first time operation and pathology place carefully to see, except is not the disease of tall calcic blood of the gland other armour shape.

If think to need again operation, should make inspection of the location before art, pathological changes makes an appointment with 2%~20% in the opportunity of mediastinum, major but cervical low of a cut operation excision, minority needs sliver breastbone.

Operation complication is made an appointment with 1% , function of the gland other permanent shell shape drops occurence rate ＜ 0.5% .

2.Only without the symptom exemple of the disease-resistant other the armour that spends disease of tall calcic blood gently needs to follow visit observation, if the following circumstance needs an operation to treat:

① bone draws the X line display of pathological changes;

② kidney function drops;

Road of make water of ③ activity sex is calculous;

3mmol/L(12mg/dl) of ≥ of ④ blood calcic level;

⑤ blood is complete hormone of the gland other armour shape (IPTH) normaller heighten 2 times above;

⑥ bone density is reduced, under 2 standard deviation that are the same as average of age of sexual distinction, of the same age, or 2.5 standard deviation that fasten young average under the same sex (ministry of lumbar, coxa and wrist ministry) ;

Disease of the mental disorder with severe ⑦ , ulcer, pancreatitis and hypertension.

2, prognostic

The operation excises week of the 1~2 after the gland other the armour shape of pathological changes is organized, bone is painful begin to reduce, 6~12 the month is improved apparently. Bone structure rehabilitate needs 2~4 year or longer. If the activity before art suffers the person that be restricted, mostly the 1~2 after art year OK and normal activity.

After the operation is excised, disease of tall calcic blood is mixed tall PTH blood is being corrected, form new secrete make water to fasten stone no longer, but the stone of department of secrete make water that already formed won't disappear, the kidney function that already caused is damaged and hypertension restores not easily also.

(editor Anne. Hospital of in relief downtown of picture origin beneficial)