Abstract Background Patients with primary hyperparathyroidism (PHPT) are at risk for severe hypocalcemia (SH) following parathyroidectomy (PTX), but limited data exist on the predictors of SH. We aimed to identify risk factors for early postoperative SH after PTX in patients with PHPT and to evaluate the predictive value of clinical parameters. Methods A retrospective review of patients with PHPT who underwent PTX between January 2010 and December 2022 was performed. A total of 46 patients were included in the study, with 15 (32.6%) experiencing postoperative SH, 19 (41.3%) having calculi in the ureter or kidney, and 37 (80.4%) having osteoporosis. Patients were divided into SH and non-SH groups based on postoperative serum calcium levels. Preoperative biochemical indicators, bone turnover markers, and renal function parameters were analyzed and correlated with postoperative SH. Results Statistically significant (P < 0.05) differences were found in preoperative serum calcium (serum Ca), intact parathyroid hormone, serum phosphorus (serum P), serum Ca/P, percentage decrease of serum Ca, total procollagen type 1 intact N-terminal propeptide, osteocalcin (OC), and alkaline phosphatase levels between the two groups. Multivariate analysis showed that serum P (odds ratio [OR] = 0.989; 95% confidence interval [95% CI] = 0.981–0.996; P = 0.003), serum Ca (OR = 0.007; 95% CI = 0.001–0.415; P = 0.017), serum Ca/P (OR = 0.135; 95% CI = 0.019–0.947; P = 0.044) and OC levels (OR = 1.012; 95% CI = 1.001–1.024; P = 0.036) were predictors of early postoperative SH. The receiver operating characteristic curve analysis revealed that serum P (area under the curve [AUC] = 0.859, P < 0.001), serum Ca/P (AUC = 0.735, P = 0.010) and OC (AUC = 0.729, P = 0.013) had high sensitivity and specificity. Conclusion Preoperative serum P, serum Ca/P and osteocalcin levels may identify patients with PHPT at risk for early postoperative SH after PTX.

Background To measure total type 1 serum amino-terminal propeptide procollagen (t-P1NP), β- type 1 cross-linked C-terminal telopeptide collagen (β-CTX), N-terminal osteocalcin (OC), and 25-(OH)-VD3 levels before parathyroidectomy (PTX) in patients with PHPT, and correlate these measurements with bone mineral density (BMD) changes at 1-year post-PTX. Methods Patients with primary hyperparathyroidism (PHPT) were followed from diagnosis to 12 months after surgery. Serum levels of calcium, parathyroid hormone (PTH), vitamin 25-(OH)-VD3, OC, β-CTX, t-P1NP, and BMD were measured before and 1 year after surgery. Results One year after PTX, mean BMD increased by 25.7, 27.7, and 33.5% in the lumbar spine (L1-L4), femoral neck (FN), and greater trochanter (GT), respectively. Percent BMD change 1-year post-PTX was significant correlated with preoperative levels of β-CTX (L1-L4: r = 0.41 , P < 0.0001; FN: r = 0.54 , P = 0.0003; GT: r = 0.46 , P = 0.0029), t-P1NP (L1-L4: r = 0.58 , P < 0.0001; FN: r = 0.73 , P < 0.0001; GT: r = 0.65 , P < 0.0001), 25-(OH)-VD3 (L1-L4: r = −0.33 , P = 0.034; FN: r = −0.48 , P = 0.002; GT: r = −0.52 , P = 0.0007), and OC (L1-L4: r = 0.49 , P = 0.0013; FN: r = 0.55 , P = 0.0002; GT: r = 0.47 , P = 0.002). Conclusions Preoperative levels of turnover markers and BMD improvements were significantly correlated in patients with PHPT 1 year after PTX.

Objective:To compare the changes of serum calcium level before and after surgical resection in patients with primary hyperparathyroidism.Methods:Two hundred and seventy-one patients with primary hyperparathyroidism were enrolled from Dec 1992 to Dec 2020 in Beijing Jishuitan Hospital. Serum calcium concentrations were measured before operation, 20 min during surgery, then 2 weeks 1-6 months , 7-12 months and 1 year respectively after operation. The baseline data of postoperative serum calcium such as sex, age, other genetic endocrine diseases, osteopathia and urolithiasis were calculated. The generalized estimation equation was used to analyze the changes of serum calcium in different types of patients before and after operation.Results:The most common postoperative hypocalcemia occurred within 2 weeks, and it occurred frequently half a year after surgery. There was no significant difference in blood calcium between male patients ( t=0.875, P=1.000) and patients with bone lesions ( t=0.034, P=3.049) from 1 to 6 months after surgery and 2 weeks after surgery. Blood calcium level in patients aged 15-35 years old from 1 to 6 months ( t=0.239, P=1.000) , from 7 to 12 months ( t=1.380, P=0.935) and 2 weeks after surgery was not statistically different. The change of bone mineral density was correlated with the change of blood calcium after operation ( F=6.895, P=0.004). Conclusions:The incidence of hypocalcemia was the highest in patients with hyperparathyroidism 2 weeks after surgery, and the blood calcium level was stable within the normal range 1 year later. The blood calcium value of male patients was still at a lower level than that of female patients within six months after surgery. In patients with bone disease, the blood calcium value was lower and recovered slowly 2 weeks after surgery. The blood calcium value of patients aged 15-35 was at a low level within 1 year after surgery.

BackgroundThe staging system for patients with anaplastic thyroid cancer (ATC) was updated in the 8th edition of the American Joint Committee on Cancer Staging Manual. A cut-off age of 55 years was stipulated as a prognostic factor for differentiated thyroid cancer; however, age was not considered for ATC patients. To this end, this study investigated the relationship between age at diagnosis and prognosis of ATC patients.MethodsThe clinical information on ATC patients was acquired from the Surveillance, Epidemiology, and End Results Program public database. Youden’s index and X-tile analyses were used to calculate the high-point age at diagnosis associated with prognosis. Cox proportional hazards models, Kaplan-Meier curves, and 1000-person-year were then used for verifying the accuracy of the high-point age.ResultsAfter inclusion/exclusion criteria was applied, 586 patients were included in this study. The high-point age was determined to be 70 years by both the Youden’s index and X-tile plot methods. The hazard ratio was 1.662 (95% confidence interval [CI]: 1.321-2.092), indicating that there was an increased risk of poor prognosis for patients > 70 years of age. The cancer-specific mortality rates per 1000-person-years for patients ≤ and > 70 years-old were 949.980 (95% CI: 827.323-1090.822) and 1546.667 (95% CI: 1333.114-1794.428), respectively. P-values were < 0.001 for the results shown above.ConclusionOur study found that age influenced the prognosis of ATC patients. Furthermore, we determined that the high-point age at diagnosis was 70 years and that > 70 years of age was associated with a poor prognosis. These results provide a useful addition to the staging manual and can improve the diagnosis, treatment strategies and prognosis of ATC patients.

Objectiv:To evaluate ultrasound, radionuclide imaging and CT in preoperative localization diagnosis of primary hyperparathyroidism (PHPT).Method:A total of 170 PHPT patients admitted to the hospital between Jan 1992 and Dec 2020 were analyzed retrospectively. The preoperative localization diagnostic efficacy of ultrasonography, radionuclide and CT alone and in combination was compared in groups.Results:The overall sensitivity of ultrasound, radionuclide and CT were 82.13%,80.43% and 75.74%. For normal positioned parathyroid adenoma: as for sensitivity of location diagnosis, ultrasound (86.67%) was higher than radionuclide (81.82%, P<0.05) and CT (80.59%, P<0.05), ultrasound/CT parallel test (94.70%, P<0.05) was higher than ultrasound alone. For specificity of location diagnosis, radionuclide (97.78%) was higher than ultrasound (91.62%) and CT (93.39%), both ultrasound/radionuclide series tests (99.00%, P<0.001)and ultrasound/CT series tests (96.94%, P<0.001) were higher than ultrasound alone. In case of ectopic parathyroid adenoma and parathyroid hyperplasia: the sensitivity and specificity of radionuclide seemed higher than ultrasound and CT. Conclusions:Ultrasound is the first choice for preoperative location diagnosis of PHPT. Ultrasound combined with radionuclide or CT can significantly improve the diagnostic efficiency of parathyroid lesions.

目的 探讨原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)合并病理性骨折的诊断和治疗方法.方法 回顾性分析北京积水潭医院2010年1月至2017年12月收治的48例PHPT合并病理性骨折并接受甲状旁腺手术患者的病例资料,对患者的病史、症状体征、实验室检查、影像学资料、围术期及术后随访情况进行总结分析.结果 48例PHPT合并病理性骨折患者术前甲状旁腺激素水平均升高,术前大多数患者出现血钙、总Ⅰ型前胶原氨基端延长肽、Ⅰ型胶原羧基端肽β特殊序列、N-端骨钙素、血碱性磷酸酶、尿钙、尿Ca/Cr升高,血磷、25-(OH)D3水平下降.术后1年患者甲状旁腺激素、血钙、总Ⅰ型前胶原氨基端延长肽、Ⅰ型胶原羧基端肽β特殊序列、N-端骨钙素、碱性磷酸酶、尿钙、尿Ca/Cr逐渐下降,血磷、25-(OH)D3水平逐渐上升,与术前比较差异均有显著性(P<0.05).术后1年复查X线、CT、骨扫描显示所有患者骨折均恢复良好.结论 实验室检查和影像学检查为PHPT合并病理性骨折的正确诊治和术后随访提供了重要依据,尽早发现并手术切除原发病灶是治疗PHPT合并病理性骨折的有效方法.

目的 分析原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)患者的临床特点,减少患者的诊治歧路及合并症.方法 回顾性分析北京积水潭医院普外科自2010年1月至2018年3月诊治的原发性甲状旁腺功能亢进患者,统计其一般资料、临床表现及处理情况、术前影像定位检查等,对再次手术资料及术中标本、术后病理、甲状旁腺激素(parathyroid hormone,PTH)等进行分析.结果 原发性甲状旁腺功能亢进症病例数逐年增加,可来源于临床多科室,根据其临床表现分型,以骨型及骨肾型为多见,各占53.2％和24.6％,其中有骨折病史者30例,占18％,曾行骨科手术者24例,占14.4％,其中行2次及以上骨科手术者5例,占骨科手术患者的21％.有骨科事件(骨折或可疑骨肿瘤者)患者PTH值与其他患者比较,差异有统计学意义(P=0.003).11例患者非初次手术,其中5例为既往异位甲状旁腺手术,占再手术的45.5％.甲状旁腺增生组与甲状旁腺癌组及腺瘤组术前PTH值差异有统计学意义(P＜0.05),3组间病灶湿质量差异无统计学意义(P>0.05).结论 对于PHPT患者应注重其临床早诊断,加强对有骨折、骨畸形变、骨质疏松等患者的筛查,术前良恶性较难确定,PTH有提示意义,应结合术前影像及术中快速PTH检测技术,做到定位准确,提高手术成功率,避免因异位多次手术,或术中反复探查等.对于复发患者,应考虑到异位病灶或甲状旁腺癌转移等.

Objective To analysis causes of reoperation for primary hyperparathyroidism and its clinical characteristics.Method The clinical data of the patients with primary hyperparathyroidism who had undergone reoperation from January 1993 to May 2017 were retrospectively analyzed.Results A total of 11 patients underwent reoperation were collected in the 226 patients with primary hyperparathyroidism.Of the 11 cases,8 cases underwent twice operations,2 cases underwent thrice operations,1 case underwent quintic operation.After the initial operation,3 cases were persistent diseases and 7 cases were recurrent diseases,1 patient was not defined as the persistent or recurrent disease.The main clinical manifestations before the reoperation were fatigue,pain in joints,bones,or muscle.The reasons for reoperation included 3 cases of ectopic parathyroid lesions,3 cases of recurrent parathyroid carcinomas,1 case of enlarged operation extent for parathyroid carcinoma,2 cases of regrowth of double parathyroid aedomas,1 case of missing adenoma,1 case of parathyroid hyperplasia.Among the location examinations,the 99Tcm-MIBI was most sensitivity (8/9).Eight cases were received reoperation on the original incision,and the remaining 3 ectopic parathyroid lesions on the new incision.After the reoperation,2 patients were lost of follow-up,1 patient died,and the remaining 8 patients had no recurrences during follow-up period.Conclusion A comprehensive approach with multiple imageology examinations which attribute to accurate location of lesions,experienced surgeons and well knowledge of parathyroid anatomy and embryology help to descend reoperation ratio and improve success rate of reoperation.

Objective To compare the clinical features and surgical effect between ectopic and orthotopic parathyroid lesions.Methods The clinical data of 136 patients with parathyroid lesions who had undergone parathyroidectomy between May 2010 and May 2017 were retrospectively analyzed.Results The ectopic parathyroid location was detected in 20 patients (14.7％) of the 136 patients with parathyroid lesions.Of the 20 patients,prevalence of superior mediastinal ectopic lesions accounted for 30.0％ (6/20),prevalence of thyrothymic ligament accounted for 20.0％(4/20),prevalence of intrathymic accounted for 15.0％ (3/20),prevalence of tracheoesophageal groove accounted for 25.0％(5/20),prevalence of submandibular accounted for 5.0％ (1/20),prevalence of carotid sheath accounted for 5.0％ (1/20),respectively.Patients with ectopic lesions had significantly higher level of serum parathyroid hormone (PTH) and alkaline phosphatase (AKP) than patients with orthotopic parathyroid lesions (P≤0.05).In addition,osteitis fibrosa cystica of metabolic bone disease was significantly more frequent in patients with ectopic parathyroid lesions than those with orthotopic parathyroid lesions (P=0.04).Preoperative ultrasonography had a sensitivity of 50.0％ (10/20) for ectopic lesions and 90.1％ (100/111) for orthotopic lesions.Preoperative 99Tcm methoxyisobutylisonitrile (99Tcm-MIBI) had a sensitivity of 100％ (19/19) for ectopic lesions and 95.3％ (101/106) for orthotopic lesions.Preoperative CT had a sensitivity of 81.3 ％ (13/14) for ectopic lesions and 93.6％ (102/109) for orthotopic lesions.Preoperative combination examination had a sensitivity of 100％ (20/20) for ectopic lesions and 99.1％ (108/109) for orthotopic lesions.Of the 20 patients with ectopic leisions,17 patients (85.0％) had undergone 1 time of operation,2 patients (10.0％) had undergone twice operations,1 patient (5.0％) had undergone trice operations.The onset of hypocalcemia happened in 13 patients (65.0％) after operation.Of 116 patients with orthotopic leisions,only 1 patient had twice operations,the onset of hypocalcemia happened in 74 patients (63.8％) after operation.The reoperation rate of orthotopic leisions was lower than that of patients with ectopic leisions (P=0.01),but there was no significant difference on the incidence of hypocalcemia (P=0.92).Excessive bleeding and recurrent laryngeal nerve injury didn't happen after all operations.Of 136 patients,111 patients had followed-up,among which 17 patients with ectopic leisions and 94 patients with orthotopic leisions.During the followed-up period,there were no recurrence happened.Conclusions The ectopic parathyroid lesions are associated with higher serum PTH and AKP levels and more frequent metabolic bone disease in comparison with the orthotopic parathyroid lesions,as well as high reoperation rate.Combined examination,including cervical ultrasonography,99Tcm-MIBI,and cervical enhanced CT are needed for preoperative location.Parathyroid lesions resection is the main surgical approach,and patients with parathyroid lesions are prone to be onset ofhypocalcemia.

目的 探讨甲状旁腺癌的诊断和治疗特点.方法 回顾性分析笔者所在医院1993年1月至2014年4月期间收治的7例甲状旁腺癌患者的临床资料.结果 7例均表现有甲状旁腺功能亢进症状,4例可触及颈部肿块.术前血钙水平2.35～4.98 mmol/L,平均值为3.07 mmol/L;甲状旁腺激素(PTH)水平78.4～2 061.7 pg/mL,平均值为1 181.5 pg/mL,较正常高值高17倍.1例首次手术在外院施行.6例首次手术在笔者所在医院施行,其中肿瘤位于左下甲状旁腺3例,右下甲状旁腺2例,右上甲状旁腺1例;1例行甲状旁腺肿瘤切除术,5例行甲状旁腺肿瘤切除+同侧腺叶全切或部分切除术,其中1例加行中央区淋巴结清扫术.有3例术后肿瘤复发均行再手术,其中1例复发3次;2例死亡;其余5例生存至今,其中已生存5年者3例.结论 综合临床表现、血钙和PTH水平、B超、99Tcm-甲氧基异丁基异腈(99Tcm-MIBI)甲状旁腺双时像扫描、术中异常发现以及病理学检查结果有助于正确诊断甲状旁腺癌.手术必须完整(en bloc)切除肿瘤,复发者可再手术治疗,需行长期随访.

甲状旁腺功能亢进-颌骨肿瘤综合征(hyperparathyroidism-jaw tumour syndrome,HPT-JT syndrome)是一种罕见遗传性内分泌疾病,国内外报道很少.我们对积水潭医院1993年1月至2014年5月收治的2例HPT-JT患者进行回顾性分析,总结其诊治特点,现报道如下.临床资料病例1 患者,男,39岁.因右上臂活动受限伴疼痛3个月,加重1个月入院.患者3个月前无明显诱因出现右上臂活动受限,偶有轻微疼痛,未给予治疗,自行缓解。

低血磷性骨软化症(hypophosphatemic osteomalacia,HO)(以往称为低磷维生素D-抵抗性软骨病)是由于低磷血症和活性维生素D产生不足造成的,以骨骼矿化不良、骨软化或佝偻病为主要特征的一组疾病,发病率约1∶25 000.分为:X连锁显性低磷性骨软化症(X-linked hypophosphatemic rickets,XLH)、常染色体显性遗传低磷性骨软化症(autosomal dominant hypophosphatemic rickets,ADHR)和肿瘤相关低磷性骨软化症(tumor-induced osteomalacia,TIO)3种类型[1].本文报道1例TIO如下.

Objective To summary the experience in diagnosis and managements for primary hyperparathyroidism(PHPT).Methods The clinical data of 73 patients with PHPT who underwent parathyroidectomy in our hospital from Jan.2003 to Dec.2010 were analyzed retrospectively.Results There were 1 case of hyperplasia(1.4%),67 cases of adenoma(91.8%),and 5 cases of adenocarcinoma(6.8%)among the 73 cases of PHPT.The common presentations involved with pain in bones and joints in 63 cases(86.3%),pathologic fractures in 17 cases(23.3%),osteoporosis in 59 cases(80.8%),fatigue in 28 cases(38.4%),abdominal pain in 4 cases(5.5%),urolithiasis in 17 cases(23.3%),malignant hypertension in 1 case(1.4%)who suffered multi-endocrine neoplasm(MEN)Ⅱa,and so on.The preoperative serum parathyroid hormone(PTH)abnormally elevated in all 73 patients,and serum calcium abnormally elevated in 59 patients(80.8%),and alkaline phosphatase abnormally elevated in 62 patients(84.9%)before operation.The positive rate of lesion locations by ultrasonography,CT,99Tcm-sestamibi(MIBI)scan,and the combination of 3 kinds of tests were 82.8%(53/64),83.3%(20/24),90.2%(46/51),and 91.8%(67/73)respectively,but 6 cases were not traced preoperatively.Parathyroidectomy was conducted to all the cases,besides,regional neck lymphadenectomy was performed for those 5 adenocarcinoma cases.Tetany in 16 cases,hoarseness in 2 cases,acute pancreatitis in 1 case,acute left heart failure in 1 case were observed after operation.Sixty nine cases were follow-up for 3-72 months(average 17.3 months).During the followed-up period,most of them were alleviated from bone pain(43 cases)and fatigue(18 cases) within 1 month.However,the recovery of PTH and serum calcium back to normality were relatively slow.One case of adenoma recurred,1 case of adenocarcinoma suffered lung metastasis,1 case of adenocarcinoma survived for 37 months prior to death for postoperative lung and bone metastasis,the other cases(including 1 case of adenocarcinoma developed from adenoma)were still alive and had no metastasis or recurrence by the end of follow-up.Conclusions The symptoms of PHPT vary and lack of specificity,hence,the enhancement of knowledge to this disease and screenings conducted for parathyroid function and serum calcium will increase the rate of diagnosis.Parathyroidectomy is the effective management for PHPT,and preoperatively accurate position contribute to minimal exploration.

This article is about a case of hepatic ectopic pregnancy. A patient suffered from an acute abdomen with 14-day vaginal bleeding. A serum, human chorionic gonadotrophin (HCG) of 8,988 mIU/mL revealed a bit of pelvic effusion. A computed tomography (CT) plain scan displayed a polygonal, moderate density shadow of the left liver lobe. An enhanced CT had no sign of intensification. A magnetic resonance imaging (MRI) plain scan was undertaken. On a T1-weighted imaging (T1WI), the lesion appeared to be a low signal; on a T2-weighted imaging (T2WI), the lesion appeared to be a high signal. With enhanced MRI, the lesion showed an irregular mild plague-like intensification during the venous phase. It was excised by an operation and chorionic tissue was seen under a microscope. The result of pathological diagnosis was hepatic ectopic pregnancy.

This article is about 3 cases of accessory lobes of the liver. Case One involved a pedunculated accessory lobe of the liver (ALL), Case Two involved a true ectopic liver, and Case Three involved a sessile accessory lobe of the liver. All 3 cases were diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI) and confirmed by surgical and histological examination. The pertinent literature on accessory lobes of the liver is also reviewed.

目的通过临床资料的分析,探讨原发性甲状旁腺功能亢进(PHPT)与甲状腺病变的关系及发病情况。方法对我院1991～2009年收治的105例PHPT病例资料进行回顾性分析,统计合并甲状腺病变的详细发病情况及相关的内分泌指标,使用SPSS统计软件分析两病并发的相关因素。结果本组病例合并甲状腺病变的并发率为39.0%,≥40岁女性并发率为60.5%。甲状腺病变主要为结节性甲状腺肿(37/41)。两病并发的主要相关因素为年龄与性别,而与甲状旁腺激素、促甲状腺激素、降钙素等因素无明显相关。结论 PHPT患者中甲状腺病变高发的原因可能是两病均高发于中老年女性。在PHPT的诊治中不能忽视甲状腺疾病的并存问题。

Objective To summarize the experience on diagnosis and treatment of primary hyperparathyroidism(PHPT).Methods Clinical data of 91 PHPT patients treated in Beijing Jishuitan Hospital from November 1992 to December 2008 were analyzed retrospectively.Results Among 91 PHPT cases,88 were diagnosed as parathyroid adenoma(96.7%),3 were diagnosed as parathyroid carcinoma (3.3%).Serum calcium and PTH levels increased in all cases.Main clinical manifestations were osteodynia and kidney stones.The accuracy rate of preoperative B-ultrasound.CT and ECT~(99m)Tc-MIBI on location was 83.5%(76/91),60.9%(14/23)and 98.6%(69/70)respectively.Parathyroidectomy was performed in all but one cases,in which parathyroid carcinoma was managed by ipsilateral hemithyroidectomy and modified neck dissection.The cure rate of primary operation was 97.8%(89/91).Ninety cases were followed-up from 8 months to 14 years postoperatively,87 cases with parathyroid adenoma achieved complete remission,2 with parathyroid carcinoma suffered from tumor recurrence and 1 died.Conclusion Patients with chronic bone diseases,repeatedly recurrent nephrolithiasis,peptic ulcer disease should be a suspect of PHPT.The routine examinations of serum calcium and phosphorus are to be conducted.UItrasonography and ECT~(99m)Tc-MIBI should be considered as the methods of first choice for preoperative localization.

对37例原发性甲状旁腺功能亢进(PHPT)患者临床资料进行回顾性分析。发现37例患者中血清碱性磷酸酶升高36例(97.3%),血钙升高33例(89.2%),血磷降低26例(70.3%),28例尿羟脯氨酸与肌酐比高于正常值。X线检查有骨质疏松者35例(94.6%),纤维囊性骨炎21例,骨膜下骨吸收30例,病理性骨折14例;27例行骨密度测定,26例(96.3%)有腰椎和左髋骨量减少或骨质疏松;所有病例经手术和病理证实为甲状旁腺腺瘤。提示重视病史的采集,常规血清碱性磷酸酶和钙磷结果分析并结合骨病X线特点,可大大提高PHPT检出率。

Objective The dynamic changes of postoperative serum ALP in PHPT have been analyzed, in order to discuss the influence on the function of osteoblast and osteoclast caused by the sudden descend of serum PTH after PTX, and make suggestions on the postoperative remedy of calcium agents.Methods Data of 48 PHPT cases with severe metabolic bone disease was gathered, and ALP-time curves of each case in postoperative period were drawn.Trend of serum calcium, serum phosphate, urine calcium, urine phosphate and PTH were statistics according to the different phases of ALP-time curve.Results Three typical phases were observed in each ALP-time curve, and the trend of serum calcium, serum phosphate, urine calcium, urine phosphate, PTH in each phase shows a certain extent regularity.Conclusion The regular changes of postoperative serum ALP indicate the influence on osteoblast and osteoclast caused by sudden fall of serum PTH. In different phase of the ALP-time curve the main factor inducing serum calcium aggradations to bone is dissimilar, and this give us important suggestions on postoperative calcium supplementation.

患者女,55岁.因右下腹隐痛5年,加重1个月于2006年4月25日入院.曾诊断慢性阑尾炎,予头孢呋辛钠及甲硝唑治疗无缓解,无其他症状.查体:右中下腹可触及约10 cm×8 cm包块,界较清,不活动,有深压痛,无反跳痛.实验室常规检查及肿瘤标志物测定均未见异常.