NIRAF技术辅助识别甲状旁腺的有效性及对术后甲状旁腺保护和甲状旁腺激素表达的影响  

Effectiveness of NIRAF technique in identification of parathyroid glands and its influence on postoperative parathyroid protection and hormone expression

作　　者：王旭 王换芳 赵风志 陈永利[1] 高晓明[1] 陈荣[1] WANG Xu;WANG Huan-fang;ZHAO Feng-zhi;CHEN Yong-li;GAO Xiao-ming;CHEN Rong(Department of General Surgery,The Second Afiliated Hospital of Xingtai Medical College,Xingtai 054000,Hebei,China;Department of Ultrasonography,The Second Afiliated Hospital of Xingtai Medical College,Xingtai 054000,Hebei,China)

机构地区：[1]邢台医学高等专科学校第二附属医院普外一科,河北邢台054000 [2]邢台医学高等专科学校第二附属医院超声科,河北邢台054000

出　　处：《生物医学工程与临床》2023年第4期476-482,共7页Biomedical Engineering and Clinical Medicine

基　　金：邢台市重点研发计划项目(2020ZC172)。

摘　　要：目的 探讨近红外自体荧光显像(NIRAF)技术辅助识别甲状旁腺的有效性及对术后甲状旁腺保护和甲状旁腺激素表达的影响。方法 选择2020年1月至2022年9月在邢台医学高等专科学校第二附属医院收治的122例甲状腺癌患者,其中男性95例,女性27例;年龄39~51岁,平均年龄45.23岁;病理类型,乳头状癌105例,滤泡性腺瘤17例;单侧切除术46例,双侧切除术76例。按照随机数表法将患者分为对照组和研究组,对照组患者行常规甲状腺癌手术,研究组患者在NIRAF技术辅助下行甲状腺切除术。比较两组患者甲状旁腺识别率、围术期指标、氧化应激指标、甲状腺功能、血钙、甲状旁腺激素(PTH)、免疫功能和并发症等参数。结果 研究组患者伤口长度、术中出血量、手术时间、术后引流量和住院时间与对照组比较,差异无统计学意义(P> 0.05)。两组患者均出现感染、发音困难和声音嘶哑等并发症,但差异无统计学意义(P> 0.05),而研究组患者术后低血钙和PTH减退比例明显低于对照组(22.95%vs 44.26%,6.56%vs 19.67%。P=0.013、0.032)。术后7 d两组患者CD3^(+)CD4^(+)和CD4^(+)/CD8^(+)水平明显提高,两组患者CD3^(+)CD8^(+)水平明显降低,且研究组患者CD3^(+)CD4^(+)和CD4^(+)/CD8^(+)水平明显高于对照组(43.83±4.59 vs 40.23±3.78,1.93±0.21 vs 1.73±0.13。P=0.000、0.000),研究组患者CD3^(+)CD8^(+)水平明显低于对照组(22.61±2.31 vs 23.81±2.62。P=0.008)。术后7 d两组患者血钙和PTH明显降低,且研究组患者血钙和PTH明显高于对照组(2.26±0.18 vs 2.15±0.25,36.98±5.16 vs 27.28±4.99。P=0.000、0.000)。研究组患者甲状腺被膜解剖前检出率为56.19%,明显高于对照组的31.19%(P=0.000);研究组患者甲状旁腺总检出率和总体准确度与对照组比较,差异无统计学意义(P> 0.05)。结论 NIRAF技术辅助识别甲状旁腺组织,可有效提高甲状腺被膜解剖前检出率,减小血钙和PTH减退幅度,增强术�Objective To study the effectiveness of near-infrared autofluorescence imaging technology(NIRAF) in identifica tion of parathyroid glands and its influence on postoperative parathyroid protection and hormone expression. Methods From January 2020 to September 2022, a total of 122 patients with thyroid cancer were enrolled, which included 95 males and 27females, aged 39-51 years old with mean age of 45.23 years old. For pathological types, 105 cases were papillary carcinoma and 17 were follicular adenoma;46 cases performed unilateral resection and 76 performed bilateral resection. All patients were divided into control group and study group according to random number table method. The control group underwent routine thyroid cancer operation and study group underwent thyroidectomy assisted by NIRAF. The parathyroid recognition rate, perioperative indexes, oxidative stress indexes, thyroid function, serum calcium, parathyroid hormone(PTH), immune function and complications were compared between 2 groups. Results There was no significant difference in wound length, intraoperative bleeding volume, operation time, postoperative drainage volume and hospitalization time between 2 groups(P<0.05). Both groups had complications such as infection, dysphonia and hoarseness, and there were no statistically significant differences between 2groups(P<0.05). The proportion of postoperative hypocalcemia and hypoparathyroidism in study group was significantly lower than that in control group(22.95 % vs 44.26 %, 6.56 % vs 19.67 %. P = 0.013, 0.032). The levels of CD3^(+)CD4^(+)T cells and CD4^(+)/CD8^(+)T cells were significantly increased, and levels of CD3^(+)CD8^(+)T cells were significantly decreased in 2 groups at 7-day post operation. The levels of CD3^(+)CD4^(+)T cells and CD4^(+)/CD8^(+)T cells in study group were significantly higher than those in control group(43.83 ± 4.59 vs 40.23 ± 3.78, 1.93 ± 0.21 vs 1.73 ± 0.13). The level of CD3^(+)CD8^(+)T cells in study group was significantly lower than that in control group(22.

关 键 词：近红外自体荧光显像技术 甲状腺癌 甲状旁腺 临床疗效 甲状旁腺激素 

分 类 号：R736[医药卫生—肿瘤]