摘要
目的探讨术中应用免疫胶体金法(ICGT)快速测定组织内甲状旁腺素(PTH)水平(以下简称PTHICGT法)的临床应用价值。方法选择2016年1~5月华中科技大学同济医学院附属同济医院甲状腺乳腺外科79例甲状腺腺叶切除手术病人,术中行PTH-ICGT法快速测定并比较分析甲状旁腺附近颈部不同组织内PTH水平;选择2016年6~12月同单位106例甲状腺全切除手术病人,随机分为PTH-ICGT组(53例)和常规肉眼组(53例),比较分析两组甲状旁腺发现率和甲状旁腺功能减退发生率。结果 79例接受甲状腺腺叶切除术病人中,PTH-ICGT法检测结果显示,甲状旁腺组织PTH浓度为(955.3±16.1)ng/L;骨骼肌组织[(14.5±1.5)ng/L]、甲状腺组织[(15.0±1.3)ng/L]、脂肪组织[(15.3±1.2)ng/L]、淋巴结组织[(14.0±1.2)ng/L]内PTH含量极低,甲状旁腺组织中PTH表达水平分别与骨骼肌、甲状腺、脂肪、淋巴结组织内PTH表达水平相比差异均有统计学意义(t值分别为23.62、33.42、39.34、30.77,P均<0.0001);PTH-ICGT法检测距离甲状旁腺周围1 mm、2 mm、3 mm、5 mm组织中PTH浓度分别为(14.6±1.5)ng/L、(16.7±1.6)ng/L、(15.1±1.4)ng/L和(13.0±1.1)ng/L,甲状旁腺组织中所测得PTH值与不同距离组织所测得PTH值差异有统计学意义(t值分别为23.62,30.68,33.42,31.50,P均<0.0001);采用常规肉眼法识别甲状旁腺组织总符合率为74.1%,PTH-ICGT法则为98.6%,两种方法比较差异有统计学意义(χ~2=35.57,P<0.0001)。106例接受甲状腺全切除手术病人中,常规肉眼组甲状旁腺发现率为92.4%,PTH-ICGT组为96.2%,两组甲状旁腺发现率比较差异无统计学意义(χ~2=0.7067,P=0.40)。两组术后暂时性甲状旁腺功能减退发生率分别为11.3%和5.7%(χ~2=1.093,P>0.05)。两组术后永久性甲状旁腺功能减退的发生率分别为3.8%和0(Fisher确切概率法检验,P=0.495)。结论 PTH-ICGT法术中甲状旁腺的识别效率较高,可能会提高临床甲状旁腺发现率并降低手术相关甲状旁腺功能减退发生率,但仍需要大样本研究进一步验证。
Objective To investigate clinical value of intraoperative rapid identification of parathyroid gland with parathyroid hormone -immune colloidal gold technique（PTH-ICGT）. Methods The data of 79 patients who received thyroid lobectomy in the Department of Breast and Thyroid Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 2016 and May 2016 were collected. Parathyroid hormone （PTH） was detected in different tissues around parathyroid gland of these patients with PTH-ICGT, and the results were conducted comparative analysis. The data of 106 patients who received total thyroidectomy between June 2016 and December 2016 were collected, who were randomly divided into PTH-ICGT group and conventional visual group, the numbers of parathyroid gland recognition and the incidence of hypoparathyroidism were analyzed between the two groups. Results Among the 79 cases who received thyorid lobectomy, PTH in parathyroid gland tissue detected by PTH-ICGT method was （955.3±16.1）ng/L which was highly expressed, while the results in skeletal muscle, thyroid tissue, adipose tissue, lymph node tissue respectively were （14.5±1.5）ng/L, （15.0±1.3）ng/L, （15.3 ±1.2）ng/L, （14.0±1.2）ng/L respectively, which were extremely low, the difference was statistically significant between PTH in parathyroid and the other tissues（t=23.62,33.42,39.34,30.77 respectively; all P〈0.0001）.The results of PTH in different distance from parathyroid gland were（955.3±16.1） ng/L （parathyroid gland / 0mm）, （14.6±1.5） ng/L（1 mm）,（16.7±1.6） ng/L（2 mm）,（15.1±1.4） ng/L（3 mm）,（13.0±1.1） ng/L（5 mm）, the difference was statistically significant between 0mm and the other different distances （t=23.62,30.68,33.42,31.50 respectively; all P〈0.0001）. The total matching percentage in the conventional visual group was 74.1%,and that in PTH-ICGT group was 98.6%（χ^2=35.57;P〈0.0001）. In the 106 patients who received total thyroidectomy, the rate of parathyroid gland detection was 92.4% in the conventional visual group（n=53）, and 96.2% in PTH-ICGT group（n=53）, the difference was not significant（χ^2=0.7067,P=0.40）. The incidence of temporary hypoparathyroidism in the conventional visual group and PTH-ICGT group were 11.3% and 5.7% （χ^2=1.093, P〉0.05）, and that of permanent parathyroid hypogonadism in the two groups was 3.8% and 0 respectively （Fisher test, P=0.495）. Conclusion The recognition efficiency of PTH-ICGT in detecting parathyroid glands was high. PTH-ICGT method may improve the rate of clinical parathyroid gland recognition and reduce the incidence of hypoparathyroidism related to the operation, but large sample studies are still needed to be further verified.
出处
《中国实用外科杂志》
CSCD
北大核心
2018年第2期227-230,237,共5页
Chinese Journal of Practical Surgery
基金
华中科技大学同济医学院研究型临床医师资助计划(No.5001540018)
关键词
免疫胶体金技术
甲状旁腺素
甲状旁腺
immune colloidal gold technique
parathyroid hormone
parathyroid gland
