超声加绘图技术在甲状旁腺定位中的应用

The value of ultrasound-assisted mapping in the preoperative localization of parathyroid gland in thyroid surgery

摘要:

目的 探讨超声辅加绘图技术对甲状腺切除过程中甲状旁腺术前定位的效果，提高甲状旁腺辨认阳性率，有效保护甲状旁腺，降低术后低钙血症发生率。方法 将头颈外科拟行甲状腺手术的160例患者按甲状腺拟全切除、单侧叶切除及年龄段平均分为A、B两组，A组患者术前采用甲状旁腺超声定位辅加手绘图标记技术，B组未采用。术中记录A组定位甲状旁腺与术中位置符合率及漏诊率、两组术中辨认率，两组甲状旁腺误切情况；术后记录两组患者血钙、甲状旁腺素（PTH）实验室检查，分析比较两组术中辨认阳性率、甲状旁腺误切率、术后第1天与术前实验室检查指标。结果 A组术前定位甲状旁腺176枚，与术中位置符合率为92.63%（176/190），另有14枚旁腺超声未检测到，漏诊率7.37%（14/190）；A组术中辨认阳性率86.36%（190/220），B组术中辨认阳性率77.27%（170/220），差异具有统计学意义（P<0.05）；A组中有2枚甲状旁腺误切除，B组中有9枚甲状旁腺误切除，A组误切率低于B组（P<0.05）；术后第1天与术前血钙及PTH实验室检查两组比较差异具有统计学意义（P<0.05）。结论 甲状腺切除术前实施超声辅加绘图技术定位甲状旁腺，对甲状腺外科手术中寻找并保留甲状旁腺及降低术后低钙血症方面有一定的临床应用价值。

Abstract:

Objective To investigate the effect of ultrasound-assisted mapping technique in preoperative localization of parathyroid gland in thyroidectomy so as to improve the positive rate of parathyroid identification, effectively protect parathyroid gland and reduce the incidence of postoperative hypocalcemia. Methods One hundred and sixty patients undergoing thyroid surgery were equally divided into two groups. Preoperatively, the patients in group A received ultrasound parathyroid positioning with hand-painted icon technology, and those in group B were given ultrasound parathyroid positioning only. The coincidence rate and missed diagnosis rate of preoperative and intraoperative localization in group A, the intraoperative identification rate and resection of parathyroid in both groups were recorded. On the first postoperative day, blood calcium and parathyroid hormone (PTH) were measured in all patients. Results In group A, 176 parathyroid glands were localized preoperatively with a coincidence rate with intraoperative localization of 92.63% (176/190), and 14 glands were not detected by ultrasound with a missed diagnosis rate of 7.37% (14/190). The positive rates of intraoperative identification in group A and B were 86.36% (190/220) and 77.27% (170/220), and the difference was statistically significant (P<0.05). Two parathyroid glands were resected by mistake in group A and 9 in group B. The rate of parathyroid gland resection in group A was lower than that in group B (P<0.05). The differences of blood calcium and PTH between the two groups on the first day after operation were statistically significant (both P<0.05). Conclusion Preoperative localization of parathyroid gland by ultrasound-assisted mapping technique in thyroidectomy may facilitate the intraoperative identification and preservation of parathyroid gland as well as the reduction of the incidence of postoperative hypocalcemia.