甲状腺外科手术中甲状旁腺识别技术研究进展  

Research progress on parathyroid gland recognition techniques during thyroid surgery

作　　者：潘新民[1] 严霞 杨屹立[1] 李小飞 马建勋[1] 何学元[1] PAN Xinmin;YAN Xia;YANG Yili;LI Xiaofei;MA Jianxun;HE Xueyuan(Department of General Surgery,Gansu Provincial Hospital,Lanzhou 730000,China;Lyuliang University,Luliang,Shanxi 033000,China)

机构地区：[1]甘肃省人民医院普通外科,甘肃兰州730000 [2]吕梁学院,山西吕梁033000

出　　处：《中国普通外科杂志》2023年第11期1787-1796,共10页China Journal of General Surgery

基　　金：吕梁学院博士科研启动基金资助项目(0304407)。

摘　　要：甲状腺癌是内分泌系统发病率最高的恶性肿瘤,全球发病率呈逐年上升趋势,手术全切是目前该疾病常用的治疗手段。甲状旁腺位于左右两叶甲状腺背面中部和下部(或埋在其中),是调节人体钙、磷代谢的关键腺体,其功能减退会导致血钙浓度降低,手足抽搐等症状,严重时可导致死亡。由于甲状旁腺体积较小且分布位置因人而异,使得甲状腺外科手术中对甲状旁腺的定位识别和功能保护极具难度,极易造成甲状旁腺损伤,导致其功能减退,引起人体血钙浓度降低等术后并发症。因此,为降低甲状腺外科手术中甲状旁腺的损伤概率,避免术后并发症的出现,笔者对甲状旁腺术中定位识别的几种主流方法进行了综述分析,主要包括基于染色法的甲状旁腺术中定位识别技术、基于光学方法的甲状旁腺术中定位识别技术和基于甲状旁腺素监测的甲状旁腺术中定位识别技术等,分析对比了各项方法的技术特点及优势,详细介绍了各方法的适用场景及其技术局限,以期推进甲状腺外科手术中甲状旁腺识别技术进一步发展,为甲状旁腺的术中快速精准识别及功能保护奠定相关技术基础。Thyroid cancer is the most common malignant tumor in the endocrine system,with a steadily increasing prevalence worldwide.Total thyroidectomy is currently a commonly used treatment for this disease.The parathyroid glands,located on the posterior mid and lower regions of the bilateral thyroid lobes(or embedded within them),are crucial for maintaining calcium and phosphorus homeostasis in the human body.Reduced function of these glands can lead to symptoms such as decreased blood calcium concentration,muscle spasms,and,in severe cases,death.Due to the small size and variable distribution of the parathyroid glands,locating and preserving them during thyroid surgery is challenging.Damage to the parathyroid glands during surgery can result in reduced function and postoperative complications,such as decreased blood calcium concentration.To reduce the risk of parathyroid damage during total thyroidectomy and prevent postoperative complications,the authors provide a comprehensive analysis of several mainstream methods for parathyroid localization and identification during thyroid surgery,which mainly include techniques based on staining methodology,optical approaches,and parathyroid hormone monitoring.The technical features and advantages of each method,providing a detailed overview of their application scenarios and technical limitations are analyzed and compared.The aim is to advance the development of parathyroid identification technology in thyroid surgery,laying a technical foundation for the rapid and accurate identification and preservation of parathyroid glands during surgery.

关 键 词：甲状腺肿瘤 甲状腺切除术 甲状旁腺 定位 识别 综述 

分 类 号：R736.1[医药卫生—肿瘤]