接触式自体荧光检测在甲状腺手术中辅助识别甲状旁腺的有效性分析  

Effectiveness of parathyroid autofluorescence contact detection in protection the parathyroid gland during thyroid surgery

作　　者：王嘉森 李进让 鞠骏 侯思源 Wang Jiasen;Li Jinrang;Ju Jun;Hou Siyuan(Department of Otorhinolaryngology Head and Neck Surgery of the Sixth Medical Center of PLA General Hospital/National Clinical Research Center for Otolaryngologic Diseases,Beijing 100048,China)

机构地区：[1]解放军总医院第六医学中心耳鼻咽喉头颈外科医学部/国家耳鼻咽喉疾病临床医学研究中心,北京100048

出　　处：《中华解剖与临床杂志》2024年第6期379-383,共5页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨接触式自体荧光检测在甲状腺手术中辅助识别甲状旁腺的有效性。方法横断面研究。前瞻性纳入2023年12月—2024年3月在解放军总医院第六医学中心耳鼻咽喉头颈外科医学部接受甲状腺手术的患者37例,其中男12例,女25例,年龄28~76(47.8±12.1)岁。手术均由具有30年甲状腺手术经验的术者完成。以经验丰富的术者肉眼识别甲状旁腺为金标准,对比分析接触式自体荧光检测与术者肉眼识别的一致性;对切除标本中的可疑甲状旁腺,对比分析自体荧光检测识别、术者肉眼识别与病理检查结果的一致性;比较术前、术后第1天和术后1个月的甲状旁腺、血清钙水平。结果对37例甲状腺手术患者的115个组织(78个在体组织和37个离体组织)进行识别对比,术者肉眼和接触式自体荧光检测分别识别到86个和87个甲状旁腺组织,25个离体组织标本均未识别到甲状旁腺。接触式自体荧光检测识别甲状旁腺的灵敏度为96.5%(83/86)、特异度为86.2%(25/29),与经验丰富的术者肉眼识别甲状旁腺的结果高度一致(Kappa=0.84)。在离体组织中,肉眼识别甲状旁腺9个,接触式自体荧光检测识别甲状旁腺13个,病理检查诊断为甲状旁腺8个,肉眼识别与病理检查诊断结果一致性较高(Kappa=0.77),接触式自体荧光检测与病理的一致性中等(Kappa=0.55)。37例患者术后第1天甲状旁腺素(32.32±18.14)ng/L和血清钙(2.21±0.17)mmol/L均低于术前的(48.73±17.36)ng/L和(2.37±0.10)mmol/L,差异均有统计学意义(t=4.39、5.39,P=0.022、0.007);术后1个月的甲状旁腺素为(47.19±17.87)ng/L、血清钙为(2.40±0.10)mmol/L均恢复至术前水平,差异均无统计学意义(t=0.42、1.97,P=0.678、0.057)。结论接触式自体荧光检测是一种甲状腺手术中辅助识别甲状旁腺的有效手段,但存在假阳性和假阴性的情况,仍需要术者在术中仔细甄别。Objective This study aimed to investigate the effectiveness of contact autofluorescence detection in the identification of parathyroid gland in thyroid surgery.Methods This cross-sectional study recruited 37 patients who underwent thyroid surgery at the Department of Otorhinolaryngology Head and Neck Surgery of the Sixth Medical Center of PLA General Hospital between December 2023 and March 2024.Among them,12 were males and 25 were females aged 28-76(47.8±12.1)years old.All operations were performed by physicians with 30 years of experience in thyroid surgery.Taking the naked eye recognition of parathyroid gland by experienced operators as the gold standard,the consistency between contact autofluorescence detection and naked eye recognition was compared and analyzed.For the suspected parathyroid glands in resected specimens,the consistency between contact autofluorescence detection and pathological results and between naked eye recognition and pathological results were compared.The levels of parathyroid gland and serum calcium were compared before operation,1 day after operation,and 1 month after operation.Results A total of 115 tissues(78 in situ and 37 in vitro)from 37 patients undergoing thyroid surgery were identified and compared.In particular,86 and 87 parathyroid tissues were identified by naked eye and tactile autofluorescence,respectively,and parathyroid glands were not identified in 25 isolated tissues.The sensitivity and specificity of contact autofluorescence detection in identifying parathyroid gland were 96.5%(83/86)and 86.2%(25/29),respectively,which were highly consistent with the results for the naked eye recognition of parathyroid gland by experienced operators(Kappa=0.84).Among the isolated tissues,9 parathyroid glands were identified by the naked eyes,13 were identified by contact autofluorescence detection,and 8 were identified by pathology.The consistency between naked eye observation and pathology was high(Kappa=0.77),and the consistency between contact autofluorescence detection and patho

关 键 词：甲状旁腺 甲状腺切除术 自体荧光 甲状旁腺功能减退 低钙血症 

分 类 号：R653[医药卫生—外科学]