吲哚菁绿荧光定位在腔镜甲状旁腺全切除术中的应用  

Application of Indocyanine Green Fluorescence Localization in Endoscopic Total Parathyroidectomy

作　　者：李文奇[1] 张梦瑶[2] 仝麟龙[1] 张开明 邢利[3] 张俊杰[1] Li Wenqi;Zhang Mengyao;Tong Linlong(Department of General Surgery, Zhengzhou People’s Hospital, Zhengzhou 450003, China)

机构地区：[1]郑州人民医院普外科,郑州450003 [2]郑州人民医院心血管内科,郑州450003 [3]郑州人民医院肾内科,郑州450003

出　　处：《中国微创外科杂志》2021年第4期309-312,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：2018年度河南省医学科技攻关计划联合共建项目(2018020827)。

摘　　要：目的探讨吲哚菁绿(indocyanine green,ICG)荧光定位在继发性甲状旁腺功能亢进患者腔镜甲状旁腺全切除术中的应用价值。方法2019年1月~2020年1月,对20例因继发性甲状旁腺功能亢进行经胸前入路腔镜甲状旁腺全切除术中采用ICG荧光定位,将25 mg ICG溶解于10 ml灭菌注射用水,术中腔镜下发现疑似甲状旁腺后取2.5 ml于外周静脉快速推注,观察甲状旁腺显影特点,切除全部甲状旁腺,监测围手术期甲状旁腺激素、血钙的变化以判断是否完全切除腺体。结果20例术中切除荧光显影定位疑似甲状旁腺腺体88枚,经术后病理证实为甲状旁腺组织共79枚(16例有4枚甲状旁腺,3例3枚,1例6枚),另外9枚为甲状腺组织。8枚肉眼未发现而使用荧光显影发现且经病理证实为甲状旁腺腺体。甲状旁腺从40 s开始显影,荧光显影高峰为70~100 s,持续至180 s开始消退;甲状腺从25 s开始显影,迅速达到高峰,持续至20 min后开始消退。切除甲状旁腺后20 min及术后2周甲状旁腺激素均明显低于术前水平。术后声音嘶哑2例,3个月恢复。术后均有低钙血症,积极静脉补钙、口服补钙及骨化醇后恢复。均随访半年,无复发。结论继发性甲状旁腺功能亢进患者行腔镜甲状旁腺全切除术时,应用ICG荧光定位有助于提高甲状旁腺检出率,且安全可行。Objective To explore the application value of indocyanine green(ICG)fluorescence localization in patients with secondary hyperparathyroidism under laparoscopic total parathyroidectomy.Methods A total of 20 patients with secondary hyperparathyroidism underwent laparoscopic total parathyroidectomy through the anterior chest approach in our hospital from January 2019 to January 2020.The 25 mg ICG was dissolved in 10 ml of sterile water for injection.After the suspected parathyroid glands were found under intraoperative laparoscopic surgery,2.5 ml was quickly injected into the peripheral vein.The characteristics of the parathyroid glands was observed.Then all parathyroid glands were removed,and the changes of parathyroid hormone and blood calcium during the perioperative period were monitored to determine whether the glands were completely removed.Results A total of 88 suspected parathyroid glands were removed by fluorescence imaging in 20 patients during the operation.There were 79 pieces of parathyroid tissue confirmed by pathology,and other 9 pieces of thyroid tissue.Among them,8 pieces were not found by the naked eye but were found by fluorescence imaging and were confirmed by pathology as parathyroid glands.Among the 20 patients,there were 16 cases with 4 parathyroid glands,1 case with 6 parathyroid glands,and 3 cases with 3 parathyroid glands.The parathyroid glands began to develop at 40 s,the peak of fluorescence imaging was 70-100 s,and continued to fade after 180 s.The thyroid began to develop at 25 s,reached the peak rapidly,and continued to fade after 20 minutes.The parathyroid hormone was significantly lower than the preoperative level 20 minutes after parathyroidectomy and 2 weeks after surgery.Two cases of hoarseness after operation,recovered within 3 months.All the patients had hypocalcemia after surgery,and recovered after active intravenous calcium supplementation,oral calcium supplementation and calciferol.All were followed up for half a year without recurrence.Conclusion When patients with secondar

关 键 词：吲哚菁绿荧光定位 继发性甲状旁腺功能亢进 腔镜甲状旁腺切除术 

分 类 号：R653[医药卫生—外科学]