黄璐, 李超, 卢漫, 杨薇, 贾世军, 蔡永聪, 孙荣昊, 王薇, 姜健, 周雨秋, 税春燕. 超声辅助下甲状腺术前甲状旁腺正显影定位初步研究[J]. 中国肿瘤临床, 2019, 46(20): 1046-1050. DOI: 10.3969/j.issn.1000-8179.2019.20.751
引用本文: 黄璐, 李超, 卢漫, 杨薇, 贾世军, 蔡永聪, 孙荣昊, 王薇, 姜健, 周雨秋, 税春燕. 超声辅助下甲状腺术前甲状旁腺正显影定位初步研究[J]. 中国肿瘤临床, 2019, 46(20): 1046-1050. DOI: 10.3969/j.issn.1000-8179.2019.20.751
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Huang Lu, Li Chao, Lu Man, Yang Wei, Jia Shijun, Cai Yongcong, Sun Ronghao, Wang Wei, Jiang Jian, Zhou Yuqiu, Shui Chunyan. Preliminary study of preoperative ultrasound-guided parathyroid localization[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2019, 46(20): 1046-1050. DOI: 10.3969/j.issn.1000-8179.2019.20.751
Citation: Huang Lu, Li Chao, Lu Man, Yang Wei, Jia Shijun, Cai Yongcong, Sun Ronghao, Wang Wei, Jiang Jian, Zhou Yuqiu, Shui Chunyan. Preliminary study of preoperative ultrasound-guided parathyroid localization[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2019, 46(20): 1046-1050. DOI: 10.3969/j.issn.1000-8179.2019.20.751
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超声辅助下甲状腺术前甲状旁腺正显影定位初步研究

Preliminary study of preoperative ultrasound-guided parathyroid localization

    摘要
  • 摘要:
      目的  探讨一种有效、精准的甲状旁腺正显影定位技术，实现甲状腺手术中甲状旁腺正显影精准定位，提高甲状旁腺辨认阳性率，有效保护甲状旁腺，提高手术安全性及根治效果，同时评估彩超检测甲状旁腺的效能。
      方法  1）对四川省肿瘤肿瘤医院头颈外科拟行甲状腺手术的患者行甲状腺患侧正常甲状旁腺的彩超检查，同时记录彩超下甲状旁腺的情况。2）在甲状腺手术患者知情同意情况下术前在彩超引导下局部注射0.1~0.5 mL亚甲蓝染色定位甲状旁腺，术中记录染色情况，术后记录患者是否出现甲状旁腺功能减退症状，如手足麻木、抽搐等，以及血清PTH、血钙情况。
      结果  1）研究共纳入拟行甲状腺手术患者50例，共检测出甲状旁腺76枚，总甲状旁腺检出率为54.29%（76/140），上甲状旁腺的检出率为40.00%（28/70），下甲状旁腺的检出率为68.57%（48/70）；2）检测出的76枚甲状旁腺在彩超上均表现为中等增强回声结节，回声强度高于甲状腺，边界清楚，回声均匀，形态多为椭圆形、类圆形等；3）研究共纳入33例术前甲状旁腺染色定位患者，术前共染色患侧甲状旁腺50枚，术中共37枚显色，总显色率为74.00%（37/50），在显色的37枚甲状旁腺中有10枚甲状旁腺术中冰冻或PTH Test证实为甲状旁腺。在纳入的33例患者中有9例出现暂时性甲状旁腺功能减退症。
      结论  彩超对于正常甲状旁腺可有效识别，并且彩超引导下甲状旁腺染色定位可在术前精准定位甲状旁腺，帮助甲状腺术中快速、有效识别。

     

    Abstract:
      Objective  To develop an effective and accurate technique for parathyroid localization to achieve precise localization before thyroid surgery. This new technique aims to improve the rate of positive parathyroid recognition, effectively protect the parathyroid glands, improve the safety and efficacy of thyroid surgery, and evaluate the efficacy of ultrasonic examination of parathyroid glands.
      Methods  Ultrasonography was performed, by an ultrasound physician, on the parathyroid glands of patients scheduled for thyroid surgery at the Head and Neck Surgery Department of Sichuan Cancer Hospital. The condition of the parathyroid gland determined on ultrasonography was recorded. Methylene blue (0.1-0.5 mL) was used to localize the parathyroid gland under ultrasonic guidance, after obtaining informed consent from the patients. Then we recorded the condition of stained parathyroid glands during operation. Symptoms of hypoparathyroidism, such as numbness of limbs and convulsions, and serum parathyroid hormone and serum calcium levels were recorded postoperatively.
      Results  A total of 76 parathyroid glands were detected in 50 patients by ultrasonic examination before thyroid surgery. The detection rate of parathyroid glands in total was 54.29% (76/140), and that of the superior parathyroid gland was 40.00% (28/70). The detection rate of the inferior parathyroid gland was 68.57% (48/70). All parathyroid glands showed medium-enhanced echo nodules on ultrasonography. Every parathyroid gland had a higher echo intensity than that of the thyroid gland, and all parathyroid glands showed a clear boundary and a uniform elliptical or round echo. In our study, the preoperative parathyroid glands were localized in 33 cases. A total of 50 parathyroid glands were localized before operation, and 37 parathyroid glands were stained (with a total staining rate of 74.0%; 37/50). Among these, 10 parathyroid glands were proven by intraoperative pathological analysis or the parathyroid hormone test. Transient hypoparathyroidism was found in nine of the patients included in this study.
      Conclusions  Ultrasonography can effectively identify normal parathyroid glands. Localization of the parathyroid gland under ultrasonic guidance before thyroidectomy is clinically feasible and this method can be used effectively for the preoperative localization of the parathyroid gland.

     

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