术前超声引导下亚甲蓝注射精确定位辅助甲状旁腺腺瘤切除术的临床研究  

Clinical study of preoperative ultrasound-guided methylene blue injection for assisting parathyroid adenoma resection

作　　者：刘君昭 赵利红 苏自杰 李国庆 段少博[3] 夏威 卢昂 李红光 LIU Jun-zhao;ZHAO Li-hong;SU Zi-jie;LI Guo-qing;DUAN Shao-bo;XIA Wei;LU Ang;LI Hong-guang(Department of Thyroid Surgery,Henan University People’s Hospital,Henan Provincial People’s Hospital,Zhengzhou 450003,China;不详)

机构地区：[1]河南大学人民医院,河南省人民医院甲状腺外科,郑州450003 [2]阜外华中心血管病医院消毒供应中心,郑州450003 [3]河南大学人民医院,河南省人民医院超声科,郑州450003 [4]河南大学人民医院,河南省人民医院内分泌科,郑州450003

出　　处：《医药论坛杂志》2020年第6期15-19,共5页Journal of Medical Forum

基　　金：河南省科技攻关计划(142102310415)。

摘　　要：目的探讨术前超声引导下亚甲蓝注射精确定位甲状旁腺腺瘤的可行性及对单发性甲状旁腺腺瘤切除术的影响。方法将2017年10月年—2019年1月河南大学人民医院需行甲状旁腺腺瘤手术治疗40例患者,随机分为亚甲蓝精确定位组和传统定位组各20例进行前瞻性对照研究。记录两组的术前、术后10 min、术后20 min、术后1天、术后6个月甲状旁腺素数值,术前、术后1天、术后6个月血钙数值,手术时间,术中出血量,术后总引流量,术后有无声音嘶哑。两组数据通过SPSS 21.0软件包进行统计学分析。结果亚甲蓝精确定位组手术操作时间(55.50±14.42)min明显小于传统定位组(98.95±27.36)min(t=-6.281,P<0.05)。亚甲蓝定位组术中出血量(11.90±5.13)mL、术后引流量(23.15±6.96)mL、术后10 min PTH(47.21±30.66)Pg/mL、术后20 min PTH(28.04±15.66)Pg/mL均少于传统定位组中出血量(22.45±10.70)mL、术后引流量(46.05±11.66)mL、术后10 min PTH(117.79±104.76)Pg/mL、术后20 min PTH(55.72±50.59)Pg/mL(t分别为-3.975、-7.540,-2.089,-2.109,P<0.05)。结论与传统定位法相比,亚甲蓝精确定位组明显减少手术操作时间、术中出血及术后引流量。亚甲蓝精确定位组术后10 min、20 min PTH低于传统定位组,术中蓝染的“甲状旁腺腺瘤”更容易完整性切除。术前超声引导下亚甲蓝精确定位能降低单发性甲状旁腺腺瘤切除术的手术难度,提高手术成功率。Objective To evaluate the feasibility of preoperative ultrasound-guided methylene blue injection to locate parathyroid adenoma and its effect on parathyroid adenoma resection.Methods Totally 40 cases of parathyroid adenoma resection,performed in Henan Provincial People's Hospital of Henan University from October 2017 to January 2019,were randomly divided into methylene blue precision localization group and traditional localization group.There were 20 cases in each group.Parathyroid hormone(PTH)values of preoperative,postoperative 10 minutes,postoperative 20 minutes,postoperative 1 day,postoperative 6 months,blood calcium values of preoperative,postoperative 1 day,postoperative 6 months,operation time,intraoperative blood loss,postoperative drainage volume,postoperative hoarseness or not were recorded.SPSS 21.0 software package was used for statistical analysis.Results The operative time(55.50±14.42)min,intraoperative blood loss(11.90±5.13)mL,postoperative drainage volume(23.15±6.96)mL,the PTH values of postoperative 10 minutes(47.21±30.66)Pg/mL and postoperative 20 minutes(28.04±15.66)Pg/mL in the methylene blue precision localization group were less than those in the traditional localization group(98.95±27.36)min,(22.45±10.70)mL,(46.05±11.66)mL,(117.79±104.76)Pg/mL,(55.72±50.59)Pg/mL.(t=-6.281,t=-3.975,t=-7.540,-2.089,-2.109,P<0.05).Conclusion Compared with the traditional localization method,methylene blue precise localization group significantly reduces the operation time,intraoperative blood loss and postoperative drainage volume.The PTH values of postoperative 10 minutes and postoperative 20 minutes in the methylene blue precise localization group were lower than those in the traditional localization group.The"parathyroid adenoma"accurately localized by methylene blue staining is easier to be removed completely.Preoperative ultrasound-guided methylene blue injection can reduce the difficulty of parathyroid adenoma resection and improve the success rate.

关 键 词：超声 亚甲蓝 定位 甲状旁腺腺瘤 

分 类 号：R736.2[医药卫生—肿瘤]