摘要
目的:探讨甲状旁腺鉴定(PGI)系统在甲状腺手术中快速鉴定甲状旁腺的临床价值。方法:收集2016年3月—2018年5月于江苏省原子医学研究所附属江原医院进行甲状腺手术的251例患者临床资料,所有患者术中用细针对可疑甲状旁腺组织进行穿刺,使用PGI系统通过检测穿刺组织液的甲状旁腺激素(PTH)浓度来鉴别是否为甲状旁腺,同时将穿刺的组织切少许送冷冻病理检查,以冷冻病理检测结果为对照标准,统计分析该鉴定系统鉴别甲状旁腺的准确性。结果:PGI系统共检测434份组织,其中无效检测16份,有效检测418份。在有效检测的组织中,PGI系统鉴定为甲状旁腺组织311份,非甲状旁腺组织组织107份;冷冻病理检查诊断为甲状旁腺组织314份,非甲状旁腺组织104份。两种检测方法有明显的一致性(к=0.969,P<0.001)。使用PGI系统识别甲状旁腺的敏感度99.0%(309/312),特异度98.1%(104/106),阳性预测值99.4%(309/311),阴性预测值97.2%(104/107),误诊率1.9%(2/104),漏诊率1.0%(3/312),准确率98.8%(413/418)。所有患者术后均无出血或感染,均未出现永久性的甲状旁腺功能减退及喉返神经麻痹。结论:PGI系统可用于甲状腺手术中鉴别甲状旁腺组织,具有速度快、准确率高、操作简便、组织损伤小等特点。
Objective: To investigate the clinical value of using parathyroid gland identification (PGI) system in rapid identification of parathyroid gland during thyroid surgery. Methods: The clinical data of 251 patients who underwent thyroid surgery in Jiangyuan Hospital Affiliated to Jiangsu Institution of Nuclear Medicine from March 2016 to May 2018 were collected. In all patients, the suspicious parathyroid gland tissues underwent fine-needle aspiration, and PGI system was used to identify whether the aspirated tissues were parathyroid gland or not by detecting the parathyroid hormone (PTH) concentration in the washing liquid of the aspirated tissues during operation. Meanwhile, a small portion of each aspirated tissue was cut off for frozen pathological analysis. Using the results of frozen pathological examination as the standard, the accuracy of the PGI system for parathyroid identification was statistically analyzed. Results: A total of 434 tissue samples were detected by the PGI system, including ineffective detection in 16 samples and effective detection in 418 samples. In the effective detected samples, 311 samples were identified as parathyroid tissue and 107 samples were identified as non-parathyroid tissue by the PGI system;314 samples were identified as parathyroid tissue and 104 samples were identified as non-parathyroid tissue by frozen pathological examination. These two detection methods showed a significant consistency (к=0.969, P<0.001). The sensitivity, specificity, positive predictive value, negative predictive value, misdiagnosis rate, missed diagnosis rate and accuracy rate of PGI system for parathyroid identification were 99.0%(309/312), 98.1%(104/106), 99.4%(309/311), 97.2%(104/107), 1.9%(2/104), 1.0%(3/312) and 98.8%(413/418), respectively. In all patients, no bleeding or infection was noted, and no permanent hypoparathyroidism and recurrent laryngeal nerve paralysis occurred after operation. Conclusion: The PGI system can be used to distinguish parathyroid tissue during thyroid surgery. It has the advantages of rapid performance, high accuracy, simple procedure and less tissue damage. So, it is recommended to be used in clinical practice.
作者
邹贤
周彬
朱国华
戴军
王国瑞
施龙顺
ZOU Xian;ZHOU Bin;ZHU Guohua;DAI Jun;WANG Guorui;SHI Longshun(Department of Thyroid Surgery, Jiangyuan Hospital Affiliated to Jiangsu Institution of Nuclear Medicine, Wuxi, Jiangsu 214063, China;Jiangsu Institution of Nuclear Medicine, Wuxi, Jiangsu 214063, China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2019年第5期537-542,共6页
China Journal of General Surgery
基金
江苏省无锡市科技发展基金资助项目(CSE31N1728)
关键词
甲状腺切除术
甲状旁腺
甲状旁腺素
即时检验
Thyroidectomy
Parathyroid Glands
Parathyroid Hormone
Point-of-Care Testing
