原发性甲状旁腺功能亢进热消融的研究进展

doi:10.3877/cma.j.issn.1674-0785.2026.02.008

原发性甲状旁腺功能亢进症是临床常见的内分泌代谢性疾病，可导致多系统靶器官损害，显著影响患者生活质量及长期预后。近年来，超声引导下热消融作为一种微创治疗方式逐渐应用于原发性甲状旁腺功能亢进的临床管理，并在多项研究中显示出较为确切的疗效及可接受的安全性。本文围绕热消融治疗原发性甲状旁腺功能亢进的研究背景、技术方法、疗效评价及并发症处理等方面进行综述，旨在为临床实践与后续研究提供参考。

关键词: 原发性甲状旁腺功能亢进, 热消融, 超声引导, 微创治疗

Primary hyperparathyroidism is a common endocrine metabolic disorder that can lead to multisystem target-organ damage, substantially impairing patients' quality of life and long-term prognosis. In recent years, ultrasound-guided thermal ablation has emerged as a minimally invasive treatment option for primary hyperparathyroidism and has demonstrated reliable efficacy with an acceptable safety profile in multiple studies. This review summarizes the research background, technical aspects, therapeutic outcomes, and complication management of thermal ablation in the treatment of primary hyperparathyroidism, with the goal of informing clinical practice and guiding future investigations.

Key words: Primary hyperparathyroidism, Thermal ablation, Ultrasound guidance, Minimally invasive therapy

图1 原发性甲状旁腺功能亢进症患者SPECT/CT图像。图a为CT：甲状腺右叶下极后方可见一类圆形软组织密度影。图b为SPECT：甲状腺床区域约右叶下极可见一轻度显像剂摄取浓聚区。图c为SPECT/CT融合断层：甲状腺右叶下极异常显像剂浓聚影。图d为SPECT：甲状腺床区域约右叶下极可见一轻度显像剂摄取浓聚区

图2 99 mTc-MIBI甲状旁腺显像。图a为甲状旁腺显像：甲状腺床区域约右叶下极可见一轻度显像剂摄取浓聚区（箭头）。图b为延迟显像：上述部位显像剂摄取明显增高（箭头）

图3 54岁女性接受微波消融术治疗原发性甲状旁腺功能亢进症的超声图像。图a为高频超声显示右侧增生的甲状旁腺（箭头）；图b为超声造影显示增生的甲状旁腺呈均匀性高增强；图c为增生性甲状旁腺周围注入隔离液（箭头）；图d为超声引导下微波消融（箭头）；图e为术后二维图像显示增生甲状旁腺消融后瘢痕（箭头）；图f为术后即刻超声造影显示消融区无对比增强（箭头）

表1 射频消融疗效

文献来源	患者数量	基线指标				末次随访指标				治愈率（%）
文献来源	患者数量	PTH（pg/ml）	血钙（mmol/L）	结节最大径（mm）	结节体积（mm³）	PTH（pg/ml）	血钙（mmol/L）	结节体积（mm³）	VRR（%）	治愈率（%）
Li等^[23]	25	180.20±147.10	2.72±0.31	17.00±6.00	642.00	57.40±25.60	2.27±0.10	19.00	86.00	84.00
Ha等^[24]	34	208.00±313.40	2.62±0.17	12.90±5.40	554.80±911.40	64.10±28.30	2.47±0.15	1.80±6.90	99.60	-
敬等^[26]	31	223.60	2.74	20.71±6.39	1444.51	53.00	2.31	124.32	-	-
Chen等^[28]	7	233.96±108.92	2.82±0.23	19.00±8.00	1400.00±1200.00	55.35±19.11	2.45±0.19	60.00±20.00	95.05	-
León等^[29]	29	152.90±50.12	2.71±0.18	11.80±4.83	-	109.25±58.25	2.54±0.11	-	-	48.27
Chai等^[30]	39	178.00	2.76±0.28	16.23±6.04	500.00	44.60	2.36±0.09	-	-	96.90

表1 射频消融疗效

文献来源	患者数量	基线指标				末次随访指标				治愈率（%）
文献来源	患者数量	PTH（pg/ml）	血钙（mmol/L）	结节最大径（mm）	结节体积（mm³）	PTH（pg/ml）	血钙（mmol/L）	结节体积（mm³）	VRR（%）	治愈率（%）
Li等^[23]	25	180.20±147.10	2.72±0.31	17.00±6.00	642.00	57.40±25.60	2.27±0.10	19.00	86.00	84.00
Ha等^[24]	34	208.00±313.40	2.62±0.17	12.90±5.40	554.80±911.40	64.10±28.30	2.47±0.15	1.80±6.90	99.60	-
敬等^[26]	31	223.60	2.74	20.71±6.39	1444.51	53.00	2.31	124.32	-	-
Chen等^[28]	7	233.96±108.92	2.82±0.23	19.00±8.00	1400.00±1200.00	55.35±19.11	2.45±0.19	60.00±20.00	95.05	-
León等^[29]	29	152.90±50.12	2.71±0.18	11.80±4.83	-	109.25±58.25	2.54±0.11	-	-	48.27
Chai等^[30]	39	178.00	2.76±0.28	16.23±6.04	500.00	44.60	2.36±0.09	-	-	96.90

表2 微波消融疗效

文献来源	患者数量	基线指标				末次随访指标				治愈率（%）
文献来源	患者数量	PTH（pg/ml）	血钙（mmol/L）	结节最大径（mm）	结节体积（mm³）	PTH（pg/ml）	血钙（mmol/L）	结节体积（mm³）	VRR（%）	治愈率（%）
Wei等^[31]	77	136.30	2.71±0.23	13.00	327.00	-	-	-	-	88.30
Zhou等^[32]	40	178.50	2.68±0.24	10.90±2.80	360.00±190.00	47.00	2.31±0.07	150.00±70.00	81.20	95.00
Wei等^[33]	67	157.30	2.75 0.26	-	560.00	39.20	2.34±0.15	-	100.00	89.40
Wu等^[34]	20	146.84±103.68	2.78±0.19	-	790.00±670.00	38.59±7.46	2.37±0.11	-	-	62.50
Wei等^[35]	87	201.20	2.80±0.30	14.00	500.00	43.60	2.30±0.20	-	88.50	85.10
魏等^[37]	96	156.30	2.71±0.18	15.00±9.00	-	47.20	2.38±0.11	-	96.65	88.54
杨等^[38]	36	264.82	2.96±0.18	-	740.00±270.00	55.95	2.42±0.07	130.00±80.00	80.57	86.11
Zhang等^[39]	35	171.31±85.91	2.69±0.11	16.20±6.40	1290.00±1570.00	35.88±7.75	2.24±0.12	-	-	-

表2 微波消融疗效

文献来源	患者数量	基线指标				末次随访指标				治愈率（%）
文献来源	患者数量	PTH（pg/ml）	血钙（mmol/L）	结节最大径（mm）	结节体积（mm³）	PTH（pg/ml）	血钙（mmol/L）	结节体积（mm³）	VRR（%）	治愈率（%）
Wei等^[31]	77	136.30	2.71±0.23	13.00	327.00	-	-	-	-	88.30
Zhou等^[32]	40	178.50	2.68±0.24	10.90±2.80	360.00±190.00	47.00	2.31±0.07	150.00±70.00	81.20	95.00
Wei等^[33]	67	157.30	2.75 0.26	-	560.00	39.20	2.34±0.15	-	100.00	89.40
Wu等^[34]	20	146.84±103.68	2.78±0.19	-	790.00±670.00	38.59±7.46	2.37±0.11	-	-	62.50
Wei等^[35]	87	201.20	2.80±0.30	14.00	500.00	43.60	2.30±0.20	-	88.50	85.10
魏等^[37]	96	156.30	2.71±0.18	15.00±9.00	-	47.20	2.38±0.11	-	96.65	88.54
杨等^[38]	36	264.82	2.96±0.18	-	740.00±270.00	55.95	2.42±0.07	130.00±80.00	80.57	86.11
Zhang等^[39]	35	171.31±85.91	2.69±0.11	16.20±6.40	1290.00±1570.00	35.88±7.75	2.24±0.12	-	-	-

表3 热消融并发症[例（%）]

文献来源	患者数量	消融方式	声音嘶哑	血肿	术后疼痛	一过性甲旁减	低钙血症	重度低钙
Li等^[23]	25	RFA	0	0	16.00%	0	4.00%	-
Ha等^[24]	34	RFA	2.94%	-	-	-	2.94%	-
敬等^[26]	31	RFA	6.45%	-	-	-	9.68%	3.23%
Peng等^[27]	37	RFA	2.70%	-	16.20%	62.20%	21.60%	-
León等^[29]	29	RFA	6.90%	-	65.50%	0	0	-
Chai等^[30]	39	RFA	5.10%	-	82.10%	-	17.90%	0.00%
Wei等^[31]	27	RFA	3.70%	0	-	66.70%	7.40%	-
Wei等^[31]	77	MWA	6.50%	2.60%	-	37.70%	2.60%	-
Zhou等^[32]	40	MWA	15.00%	0	-	2.50%	10.00%	-
Wei等^[33]	67	MWA	6.00%	-	16.40%	25.40%	3.00%	-
Wei等^[35]	87	MWA	6.90%	-	-	33.30%	4.60%	-
龚等^[36]	36	MWA	2.78%	-	-	5.56%	8.33%	-
魏等^[37]	96	MWA	5.21%	1.04%	-	25.00%	3.13%	-
杨等^[38]	36	MWA	19.44%	-	-	5.55%	8.33%	-
Zhang等^[39]	35	MWA	8.60%	-	11.40%	-	5.70%	-
Wei等^[43]	51	MWA	-	0	7.80%	17.60%	7.80%	-
Wei等^[44]	13	MWA	15.40%	0	0	7.70%	-	-

表3 热消融并发症[例（%）]

文献来源	患者数量	消融方式	声音嘶哑	血肿	术后疼痛	一过性甲旁减	低钙血症	重度低钙
Li等^[23]	25	RFA	0	0	16.00%	0	4.00%	-
Ha等^[24]	34	RFA	2.94%	-	-	-	2.94%	-
敬等^[26]	31	RFA	6.45%	-	-	-	9.68%	3.23%
Peng等^[27]	37	RFA	2.70%	-	16.20%	62.20%	21.60%	-
León等^[29]	29	RFA	6.90%	-	65.50%	0	0	-
Chai等^[30]	39	RFA	5.10%	-	82.10%	-	17.90%	0.00%
Wei等^[31]	27	RFA	3.70%	0	-	66.70%	7.40%	-
Wei等^[31]	77	MWA	6.50%	2.60%	-	37.70%	2.60%	-
Zhou等^[32]	40	MWA	15.00%	0	-	2.50%	10.00%	-
Wei等^[33]	67	MWA	6.00%	-	16.40%	25.40%	3.00%	-
Wei等^[35]	87	MWA	6.90%	-	-	33.30%	4.60%	-
龚等^[36]	36	MWA	2.78%	-	-	5.56%	8.33%	-
魏等^[37]	96	MWA	5.21%	1.04%	-	25.00%	3.13%	-
杨等^[38]	36	MWA	19.44%	-	-	5.55%	8.33%	-
Zhang等^[39]	35	MWA	8.60%	-	11.40%	-	5.70%	-
Wei等^[43]	51	MWA	-	0	7.80%	17.60%	7.80%	-
Wei等^[44]	13	MWA	15.40%	0	0	7.70%	-	-

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Thermal ablation for primary hyperparathyroidism: a review

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Thermal ablation for primary hyperparathyroidism: a review