甲状旁腺自体荧光联合纳米碳在甲状腺癌术中应用  

Clinical application study of parathyroid autofluorescence in identification of parathyroid gland in thyroid carcinoma surgery

作　　者：徐磊[1,2] 周鹏 庄大勇 李小磊 岳涛 贺青卿 Xu Lei;Zhou Peng;Zhuang Dayong;Li Xiaolei;Yue Tao;He Qingqing(Weifang Medical University,Weifang 261000;Department of Thyroid and Breast Surgery,the 960th Hospital of the PLA Joint Logistics Support Force,Jinan 250031,China)

机构地区：[1]潍坊医学院,潍坊261000 [2]解放军第九六〇医院甲状腺乳腺外科,济南250031

出　　处：《中华内分泌外科杂志》2023年第1期19-23,共5页Chinese Journal of Endocrine Surgery

基　　金：国家科技部重点研发计划专项课题子课题(2019YFC019205)。

摘　　要：目的探究近红外自体荧光显像(near-infrared autofluorescence imaging,NIRAF)技术联合纳米碳(carbon nanoparticle,CNP)负显影在甲状腺癌术中识别甲状旁腺的应用。方法前瞻性纳入2022年1月至2022年3月解放军第九六〇医院甲乳外科由同一经验丰富的医师团队实施的甲状腺全切+中央区淋巴结清扫术的80例甲状腺癌患者。术前使用随机数字表法分为对照组(40例)使用CNP负显影技术,观察组(40例)使用CNP负显影联合NIRAF技术术中识别甲状旁腺。鉴定甲状旁腺的金标准为甲状旁腺素胶体金免疫试纸检测法。对两组术中发现、原位保留、误切及移植甲状旁腺的数量进行比较,并对术后甲状旁腺素(parathyroid hormone,PTH)、血钙、血磷及出现并发症的例数进行比较。应用SPSS 25.0软件进行统计学分析。结果两组均顺利接受手术和随访。对照组和观察组术中发现并证实甲状旁腺数量分别为137、149枚,原位保留108、132枚,移植29、17枚,差异均有统计学意义(P<0.05);发现A1型甲状旁腺分别为103、109枚,原位保留84、102枚,移植19、7枚,差异有统计学意义(P<0.05)。对两组发现A2型与B型甲状旁腺数量比较差异均无统计学意义(P>0.05)。两组均未发现A3型甲状旁腺,共有3枚A3型甲状旁腺在术后病理报告中被证实。对照组术中误切甲状旁腺5枚,观察组误切2枚,差异无统计学意义(P>0.05)。对照组术后1 d PTH为17.7(5.6,30.4)pg/ml,观察组为21.7(12.8,38.3)pg/ml,差异有统计学意义(P<0.05)。两组术后1 d血钙、血磷水平差异均无统计学意义(P>0.05)。结论相较单纯使用CNP,联合NIRAF技术在甲状腺癌术中能快速、有效识别甲状旁腺,更好地原位保护甲状旁腺,减少术后甲状旁腺功能减退的发生。Objective To observe the application of near-infrared autofluorescence imaging(NIRAF)technology combined with carbon nanoparticle(CNP)negative imaging in identification of parathyroid gland(PG)during thyroid carcinoma surgery.Methods 80 patients with thyroid cancer who underwent total thyroidectomy+central lymph node dissection performed by the same experienced physician team at the 960th Hospital of the PLA from Jan.to Mar.2022 were prospectively included.Before operation,they were divided into two groups using random number table method before surgery:control group(40 cases)using CNP negative imaging,and experimental group(40 cases)using CNP negative imaging combined with NIRAF technique for intraoperative identification of PG.The gold standard for the identification of parathyroid glands was to compare the amount of intraoperative discovery retention misresection and transplantation of PG and the number of postoperative parathyroid hormone(PTH)and the number of complications in the two groups by immune colloidal gold technique.SPSS 25.0 software was used for statistical analysis.Results All patients in the two groups were successfully operated and followed up.137149 PG were found and confirmed in the control group and the observation group,108132 PG were retained in situ and 2917 PG were transplanted,the differences were statistically significant(all P<0.05);The number of A1 PG was 103 and 109,respectively.Among them,84102 were retained in situ and 197 were transplanted,the difference was statistically significant(P<0.05).There was no significant difference in the amount of A2 type PG and B type PG between the two groups(P>0.05).No A3 type PG was found in the two groups,and a total of 3 A3 types of PG were confirmed in postoperative pathological reports.There were no significant differences in misresection in the control group and the observation group,5 and 2 PG were mistakenly cut,respectively(all P>0.05).The PTH 1 day after surgery was 17.7(5.6,30.4)pg/mL in the control group and 21.7(12.8,38.3)pg/mL in the

关 键 词：甲状旁腺 自体荧光 甲状腺癌 纳米碳 

分 类 号：R736.1[医药卫生—肿瘤]