自体荧光联合示踪用盐酸米托蒽醌注射液在甲状腺术中识别甲状旁腺的临床应用  

Clinical application of autofluorescence combined with mitomycin C hydrochloride injection for parathyroid identification in thyroid surgery

作　　者：余亮 陈先恒 李海涛[2] YU Liang;CHEN Xian-heng;LI Hai-tao(Department of Clinical Medicine,Shandong Second Medical University,Weifang 261053,China;Department of Breast and thyroid surgery,Weifang Yidu Central Hospital,Weifang 262500,China)

机构地区：[1]山东第二医科大学临床医学院山东第二医科大学,山东潍坊261053 [2]潍坊市益都中心医院乳腺甲状腺外科,山东潍坊262500

出　　处：《中国现代普通外科进展》2024年第7期549-553,共5页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:在甲状腺术中,评估近红外自体荧光成像技术(NIRAF)联合示踪用盐酸米托蒽醌注射液(MHI)能否提高甲状旁腺的识别率,从而降低甲状腺术后低钙血症及甲状旁腺功能减退的发生率。方法:前瞻性连续选取2022年10月—2023年3月在潍坊市益都中心医院行甲状腺手术治疗的患者80例,根据入院时间随机将患者分为联合组和对照组,每组40例。联合组术中于甲状腺内注射MHI 0.6 mL并联合NIRAF识别甲状旁腺,对照组仅于术中使用NIRAF。比较两组术前血钙、甲状旁腺激素(PTH)水平,术中甲状旁腺识别准确率、自体移植率,术后甲状旁腺激素(PTH)、血钙水平、甲状旁腺误切率及低钙症状发生率。结果:联合组行甲状旁腺移植术4例(10.0%),对照组12例(30.0%),两组之间差异有统计学意义(χ^(2)=3.828,P=0.049)。联合组甲状旁腺识别准确率高于对照组(98.11%比85.96%,χ^(2)=3.899,P=0.048),且联合组存在误切甲状旁腺2例(5.0%),对照组10例(25.0%),两组对比差异有统计学意义(χ^(2)=4.804,P=0.028)。术后1 d,联合组及对照组血钙水平分别为(2.24±0.11)mmol/L及(2.16±0.17)mmol/L,PTH水平分别为(27.18±11.77)ng/L及(18.57±9.55)ng/L,差异均有统计学意义(P<0.05)。术后3 d,联合组血钙水平为(2.32±0.17)mmol/L,对照组为(2.23±0.12)mmol/L;联合组PTH水平为(33.03±7.88)ng/L,对照组为(24.89±9.29)ng/L;两组差异均有统计学意义(P<0.05)。联合组术后出现手足或口周麻木症状3例(7.5%),对照组10例(25.0%),差异有统计学意义(P=0.034)。结论:自体荧光联合示踪用盐酸米托蒽醌注射液可以有效提高甲状腺术中甲状旁腺识别的准确率,从而避免误切,减少术后低钙血症及甲状旁腺功能减退发生率,降低患者术后手足、口周麻木感的发生,提高患者就医体验。Objective:In thyroid surgery,evaluating the combination of near-infrared autofluorescence imaging(NIRAF)with injection of mitoxantrone hydrochloride(MHI)as a tracer to enhance the identification rate of parathyroid glands,thereby reducing the occurrence of post-thyroidectomy hypocalcemia and parathyroid dysfunction.Methods:A prospective study was conducted from October 2022 to March 2023 at Yidu Central Hospital in Weifang City,involving 80 patients undergoing thyroid surgery.Patients were randomly divided into a combined group and a control group based on their admission time,with 40 patients in each group.In the combined group,0.6 mL of mitoxantrone hydrochloride(MHI)was injected into the thyroid gland during surgery,and near-infrared autofluorescence(NIRAF)was used for parathyroid gland identification.The control group only used NIRAF during surgery.Compared the preoperative levels of serum calcium and parathyroid hormone(PTH)between the two groups,as well as the intraoperative accuracy of parathyroid gland identification and the rate of autotransplantation.Postoperatively,the study analyzed PTH levels,blood calcium levels,the rate of inadvertent parathyroidectomy,and the incidence of hypocalcemia symptoms.Results:In the combined group,there were 4 cases(10.0%)of parathyroid transplantation,compared to 12 cases(30.0%)in the control group,with a statistically significant difference between the two groups(χ^(2)=3.828,P=0.049).The accuracy of parathyroid gland identification in the combined group was higher than that in the control group(χ^(2)=3.899,P=0.048).Additionally,there were 2 cases(5.0%)of inadvertent parathyroidectomy in the combined group compared to 10 cases(25.0%)in the control group,with a statistically significant difference between the two groups(χ^(2)=4.804,P=0.028).Postoperatively at day 1,the blood calcium levels were(2.24±0.11)mmol/L in the combined group and(2.16±0.17)mmol/L in the control group,and the PTH levels were(27.18±11.77)ng/L in the combined group and(18.57±9.55)ng/L in the co

关 键 词：自体荧光 盐酸米托蒽醌注射液 甲状腺切除术 甲状旁腺 甲状旁腺功能减退症 

分 类 号：R653[医药卫生—外科学]