甲状腺手术中细针穿刺免疫层析法快速检测甲状旁腺组织的应用研究
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摘要
目的探讨甲状腺手术中应用细针穿刺免疫层析法快速检测甲状旁腺组织的临床应用价值。方法选择2018年1月至2018年10月行甲状腺手术的患者102例进行前瞻性研究,随机分为两组,实验组(52例)应用免疫层析法检测甲状旁腺;对照组(50例)应用肉眼识别法识别甲状旁腺。采用SPSS 19. 0统计软件分析,术前、术后血钙和甲状旁腺素水平用均数±标准差表示,独立t检验;甲状旁腺识别率采用χ~2检验。P <0. 05为差异有统计学意义。结果与术中冰冻病理检查结果比较显示:肉眼法识别甲状旁腺与术中冰冻病理学结果比较,符合率为77. 0%(47/61);免疫层析法识别符合率为97. 4%(75/77)。两种识别方法差异有统计学意义(χ~2=35. 57,P <0. 0001)。在甲状腺腺叶切除的良性病例中,实验组和对照组术后血钙和甲状旁腺激素水平基本相似,差异无统计学意义(P> 0. 05)。在甲状腺恶性肿瘤病例中,实验组血钙和甲状旁腺素明显高于对照组,差异有统计学意义(P <0. 05)。结论术中应用细针穿刺免疫层析法有助于对甲状旁腺组织的判别,方便快捷,避免损伤甲状旁腺,降低甲状旁腺功能减退的发生率。
Objective To investigate the clinical value of immunochromatographic assay in the rapid detection of parathyroid tissue by fine needle aspiration in thyroid surgery. Methods Prospective study were performed from January 2018 to October 2018,and 102 patients underwent thyroidectomy,were enrolled,whom were randomly divided into immunochromatographic group( 52 cases) and control group( 50 cases). Statistical analysis was performed by using SPSS 19. 0 software. Measurement data including perioperative level of blood calcium and PTH were expressed as mean ± standard deviation and examined by using t test. The recognition rate were compared by using chi square test. A P value of < 0. 05 was considered as statistically significant difference. Results Compared with intraoperative frozen pathological results,the recognition rate was 77. 0%( 47/61) in the control group,and 97. 4%( 75/77) in the immunochromatographic group,with significant difference between two groups( χ2= 35. 57,P < 0. 0001).In cases of benign lesions with thyroidectomy,the serum calcium and parathyroid hormone levels of patients were similar in both immunochromatographic group and control group, with no significant difference( P > 0. 05). In cases of thyroid malignancies with thyroidectomy,the serum calcium and parathyroid hormone levels of patients in immunochromatographic group was significantly higher than those in the control group respectively( P < 0. 05). Conclusion Intraoperative fine needle aspiration by using immunochromatographic method is helpful to distinguish parathyroid tissue,which is convenient and rapid,and could avoid injury of parathyroid gland and could reduce the incidence of hypoparathyroidism.
Objective To investigate the clinical value of immunochromatographic assay in the rapid detection of parathyroid tissue by fine needle aspiration in thyroid surgery. Methods Prospective study were performed from January 2018 to October 2018,and 102 patients underwent thyroidectomy,were enrolled,whom were randomly divided into immunochromatographic group( 52 cases) and control group( 50 cases). Statistical analysis was performed by using SPSS 19. 0 software. Measurement data including perioperative level of blood calcium and PTH were expressed as mean ± standard deviation and examined by using t test. The recognition rate were compared by using chi square test. A P value of < 0. 05 was considered as statistically significant difference. Results Compared with intraoperative frozen pathological results,the recognition rate was 77. 0%( 47/61) in the control group,and 97. 4%( 75/77) in the immunochromatographic group,with significant difference between two groups( χ2= 35. 57,P < 0. 0001).In cases of benign lesions with thyroidectomy,the serum calcium and parathyroid hormone levels of patients were similar in both immunochromatographic group and control group, with no significant difference( P > 0. 05). In cases of thyroid malignancies with thyroidectomy,the serum calcium and parathyroid hormone levels of patients in immunochromatographic group was significantly higher than those in the control group respectively( P < 0. 05). Conclusion Intraoperative fine needle aspiration by using immunochromatographic method is helpful to distinguish parathyroid tissue,which is convenient and rapid,and could avoid injury of parathyroid gland and could reduce the incidence of hypoparathyroidism.
引文
[1]王深明,叶润仪.甲状腺微小癌诊断与外科治疗规范化[J].中华普外科手术学杂志:电子版,2013,7(4):246-249.
[2] Calo PG,Conzo G,Raffaelli M,et a1. Total thyroidectomy alone versus ipsilateral versus bilateral prophylactic central neck dissection in clinically node-negative differentiated thyroid carcinoma. A retrospective multicenter study[J]. Eur J Surg Oncol,2017,43(1):126-132.
[3]张敏,周蕾.三种甲状腺全切除术式的临床疗效及对甲状旁腺功能的影响对比[J/CD].中华普外科手术学杂志(电子版),2018,12(3):261-264.
[4] Paek SH,Lee YM,Min SY,et al. Risk factors of hypoparathyroidism following total thyroidectomy for thyroid cancer[J]. World J Surg,2013,37(1):94 101.
[5]王兴,朱一鸣,黄辉,等.甲状腺癌术中甲状旁腺误切危险因素分析[J].中国实用外科杂志,2017,37(9):1028-1031.
[6]杜峻峰,郝雪梅,季锡清,等.纳米碳示踪剂在甲状腺微小乳头状癌手术中的应用[J/CD].中华普外科手术学杂志(电子版),2016,10(5):383-386.
[7]尹峰燕,邢浩,张晓健,等.纳米碳混悬液在甲状腺术中对甲状旁腺的保护作用[J].中华内分泌外科杂志,2015,9(2):144-146.
[8] Kim SM,Kim HK,Kim KJ,et a1. Recovery from permanent hypoparathyroidism after total thyroidectomy[J]. Thyroid,2015,25(7):830-833.
[9]钟琦,房居高,马泓智,等.经静脉低剂量亚甲蓝甲状旁腺定位在甲状腺手术中的初步应用[J].中国耳鼻咽喉头颈外科,2016,23(5):247-249.
[10]陈维平,谢芸.甲状腺癌根治术中发生喉返神经损伤的因素分析[J/CD].中华普外科手术学杂志:电子版,2016,10(2):159-161.
[11]宋琦,李晓明.甲状腺手术中甲状旁腺和喉神经功能损伤的防治策略[J].中国肿瘤临床,2017,44(9):409-414.
[12]冯云,杨大章,程靖宁,等.甲状腺外科手术操作与手术并发症的相关性[J].山东大学耳鼻喉眼学报,2015,29(1):78-82.
[13]何高飞,高力,宋春轶,等.术中甲状旁腺辨识方法的研究进展[J].中华内分泌外科杂志,2017,11(4):345-348.
[14] Pradeep PV,Ramalingam K. Postoperative PTH measurement is not a reliable predictor for hypocalcemia after total thyroidectomy in vitamin D deficiency:prospective study of 203 eases[J]. World J Surg,2014,38(3):564-567.
[15]刘利敏,陈勇,张琰,等.甲状腺再次手术中甲状旁腺损伤的危险因素分析[J].浙江临床医学,2015,17(9):1592-1593.
[2] Calo PG,Conzo G,Raffaelli M,et a1. Total thyroidectomy alone versus ipsilateral versus bilateral prophylactic central neck dissection in clinically node-negative differentiated thyroid carcinoma. A retrospective multicenter study[J]. Eur J Surg Oncol,2017,43(1):126-132.
[3]张敏,周蕾.三种甲状腺全切除术式的临床疗效及对甲状旁腺功能的影响对比[J/CD].中华普外科手术学杂志(电子版),2018,12(3):261-264.
[4] Paek SH,Lee YM,Min SY,et al. Risk factors of hypoparathyroidism following total thyroidectomy for thyroid cancer[J]. World J Surg,2013,37(1):94 101.
[5]王兴,朱一鸣,黄辉,等.甲状腺癌术中甲状旁腺误切危险因素分析[J].中国实用外科杂志,2017,37(9):1028-1031.
[6]杜峻峰,郝雪梅,季锡清,等.纳米碳示踪剂在甲状腺微小乳头状癌手术中的应用[J/CD].中华普外科手术学杂志(电子版),2016,10(5):383-386.
[7]尹峰燕,邢浩,张晓健,等.纳米碳混悬液在甲状腺术中对甲状旁腺的保护作用[J].中华内分泌外科杂志,2015,9(2):144-146.
[8] Kim SM,Kim HK,Kim KJ,et a1. Recovery from permanent hypoparathyroidism after total thyroidectomy[J]. Thyroid,2015,25(7):830-833.
[9]钟琦,房居高,马泓智,等.经静脉低剂量亚甲蓝甲状旁腺定位在甲状腺手术中的初步应用[J].中国耳鼻咽喉头颈外科,2016,23(5):247-249.
[10]陈维平,谢芸.甲状腺癌根治术中发生喉返神经损伤的因素分析[J/CD].中华普外科手术学杂志:电子版,2016,10(2):159-161.
[11]宋琦,李晓明.甲状腺手术中甲状旁腺和喉神经功能损伤的防治策略[J].中国肿瘤临床,2017,44(9):409-414.
[12]冯云,杨大章,程靖宁,等.甲状腺外科手术操作与手术并发症的相关性[J].山东大学耳鼻喉眼学报,2015,29(1):78-82.
[13]何高飞,高力,宋春轶,等.术中甲状旁腺辨识方法的研究进展[J].中华内分泌外科杂志,2017,11(4):345-348.
[14] Pradeep PV,Ramalingam K. Postoperative PTH measurement is not a reliable predictor for hypocalcemia after total thyroidectomy in vitamin D deficiency:prospective study of 203 eases[J]. World J Surg,2014,38(3):564-567.
[15]刘利敏,陈勇,张琰,等.甲状腺再次手术中甲状旁腺损伤的危险因素分析[J].浙江临床医学,2015,17(9):1592-1593.