近红外/吲哚菁绿荧光成像技术联合纳米炭在甲状腺癌全切术中识别甲状旁腺中的应用  

Near-infrared fluorescent/indocyanine green imaging combined with carbon nanoparticles in thyroid cancer parathyroid gland identification during total resection

作　　者：郑璐[1] 汤铜[1] 王帅 孟磊 徐伟民[1] 王芝涛 蔡惠明 ZHENG Lu;TANG Tong;WANG Shuai;MENG Lei;XU Weimin;WANG Zhitao;CAI Huiming(Department of Thyroid and Breast Surgery;Department of Hematology,the Second Affiliated Hospital of Anhui Medical University,Anhui Hefei 230601,China;Nanjing Nuoyuan Medical Instrument Co.,LTD.,Jiangsu Nanjing 210004,China.)

机构地区：[1]安徽医科大学第二附属医院甲状腺乳腺外科 [2]安徽医科大学第二附属医院血液科,安徽合肥230601 [3]南京诺源医疗器械有限公司,江苏南京210004

出　　处：《现代肿瘤医学》2024年第15期2752-2759,共8页Journal of Modern Oncology

基　　金：国家自然基金青年项目(编号:82200825);吴阶平医学基金会临床科研专项资助基金(编号:320.6750.2021-10-25);安徽省高等教育人文社会科学重点项目(编号:SK2021A0167);安徽医科大学校科研基金资助项目(编号:2018xkj038)。

摘　　要：目的:评估近红外/吲哚菁绿荧光成像(near-infrared fluorescent/indocyanine green, NIRF/ICG)技术联合纳米炭在甲状腺癌全切术中对甲状旁腺的识别效果。方法:选取在我院行甲状腺癌全切手术的100例患者临床基本资料,根据患者入院时间分为单独使用纳米碳组50例和近红外/吲哚菁绿荧光成像技术联合纳米炭组50例。联合组术中联合近红外/吲哚菁绿荧光成像技术同时术中注射纳米炭识别甲状旁腺,并通过术中甲状旁腺试纸快速检测确诊是否为甲状旁腺。比较两组患者甲状旁腺识别率、准确率及暂时性、永久性甲状旁腺功能减低发生率。根据荧光强度分析术后发生暂时性及永久性甲状旁腺功能减退风险,单因素分析探索影响荧光强度的因素,探索荧光强度与暂时性甲状旁腺发生风险相关性。结果:两组患者的性别、年龄、身高、体重、体质量指数(body mass index,BMI)(P=0.384 1)、术前甲状旁腺激素(parathyroid hormone,PTH)(P=0.964 1)、术前血清钙(P=0.356)差异均无统计学意义。联合组甲状旁腺识别率88%(176/200),纳米炭组识别率63%(126/200),比较差异有统计学意义(P<0.01);联合组准确率为96.59%(170/176),纳米炭组准确率为87.30%(110/126),比较差异有统计学意义(P<0.01)。联合组术后常规病理1枚误切的甲状旁腺,单独纳米碳组术后发现5枚误切的甲状旁腺。联合组术后第一天有10例患者出现暂时性甲状旁腺功能减低,单独纳米炭组共22例患者出现暂时性甲状旁腺功能减低;联合组术后1天血钙为(2.15±0.07)mmol/L,纳米碳组为(2.09±0.10)mmol/L,差异有统计学意义(P=0.002 438);术后6个月联合组患者出现1例永久性甲状旁腺功能减低,纳米碳组出现5例永久性甲状旁腺功能减低。单因素回归分析结果显示性别(β=-0.383 541 6;95%CI:0.2~2.35;P=0.538 595 3);身高(β=-0.044 147 54;95%CI:0.89~1.03;P=0.233 478 2);BMI(β=-0.173 074 1;95%CI:0.66~1.04;P=0.125 803 Objective:To evaluate the efficacy of near-infrared fluorescent/indocyanine green(NIRF/ICG)combined with carbon nanoparticles in the identification of parathyroid gland during total thyroidectomy.Methods:The clinical data of 100 patients with thyroid cancer undergoing total thyrotomy in our hospital were selected,and the patients were divided into 50 cases using nano carbon alone and 50 cases using near infrared/indocyanine green fluorescence imaging combined with nano carbon according to the time of admission.In the combined group,near infrared/indocyanine green fluorescence imaging combined with carbon nanoparticles were used to identify parathyroid glands during operation,and parathyroid glands were quickly detected by intraoperative parathyroid strip.The identification rate and accuracy of parathyroid gland and the incidence of temporary and permanent parathyroid dysfunction were compared between the two groups.The risk of transient and permanent hypoparathyroidism was analyzed according to fluorescence intensity,and the factors affecting fluorescence intensity were investigated by single factor analysis.To explore the correlation between fluorescence intensity and the risk of transient parathyroid development.Results:There were no significant differences in gender,age,height,weight,body mass index(P=0.3841)preoperative parathyroid hormone(PTH)(P=0.9641)and preoperative serum calcium(P=0.356).The parathyroid identification rate of the combined group was 88%(176/200),and that of the nanocarb group was 63%(126/200),which had statistical significance(P<0.01).The accuracy of the combined group was 96.59%(170/176),and that of the carbon nanoscale group was 87.30%(110/126).The difference was statistically significant(P<0.01).In the combined group,one parathyroid gland was mistakenly cut by routine pathology,while five parathyroid glands were found in the nano carbon group.Temporary decreased parathyroid function occurred in 10 cases in the combined group and 22 cases in the carbon nanoscale group one day after surg

关 键 词：近红外/吲哚菁绿荧光成像 纳米碳 甲状腺癌 甲状旁腺功能减退 

分 类 号：R736.1[医药卫生—肿瘤]