自体荧光基点光谱联合胶体金检测异位微小旁腺指导继发性甲状旁腺功能亢进手术的疗效  

Efficacy of autofluorescence point-spectral analysis combined with the immune colloidal gold technique for the detection of ectopic microscopic parathyroid glands to guide surgery for secondary hyperparathyroidism

作　　者：彭琨 姚宝忠[1] 陈宏存[1] 张军[1] 包文中[1] 李文波[1] 宋伟涛 桑赛龙 林丽 贾志兴 李良[1] PENG Kun;YAO Baozhong;CHEN Hongcun;ZHANG Jun;BAO Wenzhong;LI Wenbo;SONG Weitao;SANG Sailong;LIN Li;JIA Zhixing;LI Liang(Department of General Surgery,the Second People's Hospital of Hefei,the Second People's Hospital of Hefei Affiliated to Bengbu Medical University,Hefei 230011,Anhui,China)

机构地区：[1]合肥市第二人民医院(蚌埠医科大学附属合肥市第二人民医院)普外科,安徽合肥230011

出　　处：《实用医学杂志》2024年第20期2905-2912,共8页The Journal of Practical Medicine

基　　金：安徽省临床医学研究转化专项科研项目(编号:202304295107020093);安徽省新时代育人质量工程研究生学术创新项目(编号:2023cxcysj155);合肥市卫生健康委员会应用医学科研项目(编号:Hwk2023zc011);蚌埠医科大学自然科学重点项目(编号:2022byzd210);合肥市第二人民医院科研重点项目(编号:2022yzd004)。

摘　　要：目的评估术中以自体荧光基点光谱分析(AFPSA)联合免疫胶体金法(ICGT)检测颈中央区异位甲状旁腺组织指导甲状旁腺全切术(TPTX)或廓清术(CPTX)治疗继发性甲状旁腺功能亢进(SHPT)的效果。方法回顾性收集并对比2019年10月至2023年6月的64例SHPT患者的临床数据,36例观察组先行TPTX术,于颈中央区用AFPSA测得可疑目标取样再以ICGT检测,若为阳性的再行CPTX术;28例对照组术中未经特殊检测而仅行TPTX术。对比两组患者的手术资料、甲状旁腺激素(PTH)、血钙、血磷、碱性磷酸酶(ALP)、临床症状转归、甲状旁腺功能变化及低钙血症发生情况等。结果观察组AFPSA-ICGT阳性者9例,其中左2例,右4例,胸腺3例;9例阳性中有轻度增生或未增生微小旁腺10处。两组在切除含异位在内的总旁腺数上差异有统计学意义(P<0.05)。观察组的ALP低于对照组,在术后3个月(P<0.01)和术后6个月(P<0.001)差异有统计学意义;在术后6个月,PTH低于对照组,差异有统计学意义(P<0.05),血磷低于对照组,差异有统计学意义(P<0.001)。对照组部分患者术后6个月关节骨痛和皮肤瘙痒再发(P<0.05)。观察组SHPT复发情况优于对照组(P<0.05);而术后甲状旁腺功能减退或亢进及低钙情况的差异无统计学意义(P>0.05)。结论以AFPSA-ICGT术中检测指导SHPT手术,可精准高效地识别并安全靶向地清除颈中央区内未明显增生的甲状旁腺组织,对改善预后效果显著。Objective To evaluate the intraoperative identification of ectopic parathyroid tissue in the central neck region using autofluorescence point-spectral analysis(AFPSA)combined with immune colloidal gold technique(ICGT),for guiding total parathyroidectomy(TPTX)or clean parathyroidectomy(CPTX)in the management of secondary hyperparathyroidism(SHPT).Methods Retrospectively collected and compared the clinical data of 64 patients with SHPT from October 2019 to June 2023.In the observation group,TPTX was performed as the initial procedure in 36 cases,followed by sampling of suspicious targets using AFPSA in the central neck area and subsequent detection through ICGT.CPTX was then conducted if a positive result was obtained.On the other hand,the control group consisted of 28 cases where only TPTX was performed without any additional tests during surgery.The surgical data,parathyroid hormone(PTH)levels,blood calcium levels,blood phosphorus levels,alkaline phosphatase(ALP)levels,regression of clinical symptoms,changes in parathyroid function and occurrence of hypocalcemia were compared between these two groups.Results In the observation group,there were 9 cases of AFPSA-ICGT positivity,including 2 left-sided cases,4 right-sided cases,and 3 thymic cases;among these positive cases,there were a total of 10 locations with mildly hyperplastic or nonhyperplastic microscopic parathyroid tissue.The difference in the number of total parathyroid glands removed(including ectopic)between the two groups was statistically significant(P<0.05).At both 3 and 6 months postoperatively,ALP levels in the observation group were significantly lower than those in the control group(P<0.01 and P<0.001 respectively);at 6 months postoperatively,differences in PTH and blood phosphorus levels between the two groups were also statistically significant(P<0.05 and P<0.001 respectively).Joint bone pain and skin itching recurred in some patients within the control group at six months after surgery(P<0.05),whereas recurrence of SHPT was less frequent within

关 键 词：自体荧光基点光谱分析 免疫胶体金法 甲状旁腺全部切除术 甲状旁腺廓清术 继发性甲状旁腺功能亢进 

分 类 号：R653[医药卫生—外科学]