术中穿刺检测鉴别淋巴结与甲状旁腺28例临床研究  

Intra- operative puncture and identification for lymph nodes and parathyroid glands: A clinical study of 28 patients

作　　者：李永平[1] 杨莉[2] 李南林[1] 王廷[1] 黄美玲[1] 凌瑞[1] 

机构地区：[1]第四军医大学西京医院甲乳血管外科,陕西西安710032 [2]第四军医大学西京医院病理科,陕西西安710032

出　　处：《中国实用外科杂志》2016年第11期1224-1226,共3页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金(No.8157110197)

摘　　要：目的探讨术中穿刺快速检测鉴别淋巴结和甲状旁腺的可行性。方法选择2014年1-7月第四军医大学西京医院收治的28例甲状腺癌病人,均行甲状腺癌根治术。行术中冰冻病理学检查的同时进行术中穿刺快速检测,比较两种方法的敏感度、特异度等诊断效能指标。结果 28例病人术中共检出40枚可疑结节,包含29枚可疑甲状旁腺、9枚可疑淋巴结、2枚可疑结节。甲状旁腺的术中总检出率为27.5%(11/40),淋巴结的总检出率为37.5%(15/40)。冰冻病理学检查与术后病理学检查一致,故以其为金标准,术中穿刺快速检测鉴定淋巴结的准确率为100%,鉴定甲状旁腺的准确率为93.1%(1例假阳性),敏感度为100%,特异度为97.0%。结论术中穿刺快速检测可准确鉴别术中可疑淋巴结,有助于甲状旁腺的保护及原位保留。Objective To explore the feasibility of intra-operative puncture and real-time identification of lymph nodes and parathyroid glands. Methods A total of 28 thyroid cancer patients hospitalized into Xijing Hospital, the Fourth Military Medical University between January 2014 and July 2014 were included into the study and proceeded with radical surgery. When intra-operative frozen pathological detection proceeded, the intra-operative puncture and real-time identification was started at the same time. Finally, the diagnostic efficiency such as sensitivity and specificity of two methods was evaluated. Results A total of 40 suspicious nodes were distinguished in 28 patients, including 29 suspicious parathyroid glands, 9 suspicious lymph nodes and 2 other suspicious nodes. Intra-operative identification rate of parathyroid glands was 27.5% （11/40）, while that of lymph nodes was 37.5% （15;40）. Bases on the gold standard of frozen pathological results, the accuracy rate of lymph node and parathyroid glands detection was 100% and 93.1%, respectively. Meanwhile, the sensitivity and specificity of intra-operative parathyroid distinction was 100% and 97.0%. Conclusion The intra-operative rapid detection plays a significant role in distinguishing lymph nodes, which may enhance the protection and in-situ retention of parathyroid glands.

关 键 词：甲状腺癌根治术 术中快速鉴别 甲状旁腺 原位保留 

分 类 号：R6[医药卫生—外科学]