Objective To explore the feasibility of rapid identification of parathyroid with fluorescence microsphere immunochromatography during thyroid and parathyroid surgery. Methods Clinical data of 36 patients who underwent thyroid and parathyroid surgery by same surgical group in Department of Thyroid Surgery First Hospital of Jilin University from July 2017 to October were collected. The parathyroid and non-parathyroid tissue such as thyroid, fat tissue and lymph node which were resected were punctured by same operator using 1 mL needle. The T1 (test value) and C (control value) were measured by fluorescence microsphere immunochromatography. T1/C were compared between different tissues and T1/C of the punctured tissue compared with the pathological diagnosis. Results A total of 51 sets of data were obtained. T1/C of parathyroid was (3.653± 3.177) and T1/C of non-parathyroid tissue was (0.056± 0.027) with statistically significant diffe-rence(P< 0.01). T1/C of parathyroid was significantly higher from that of non-parathyroid tissue including thyroid, lymph node and fat tissue (P< 0.05). There was no significant difference between T1/C of parathyroid and parathyroid adenomas (P> 0.05). The results of immunofluorescence test to identify parathyroid had sensitivity (true positive rate) 95.7% (22/23), specificity (true negative rate) 100% (28/28), false positive rate (misdiagnosis rate) 0 (0/28), false negative rate (omission diagnostic rate) 4.4% (1/23) and accuracy 98.0% (50/51). Conclusions Fluorescence microsphere immunochromatography can be used to identify parathyroid in real-time mode during surgery with high sensitivity and specificity, which is a convenient procedure and valuable to be recommended.
YAN Zewen, WANG Peisong, ZOU Xian, TONG Hailei, LU Qiyu, HAN Hui, YANG Shuai, MENG Wei, CHEN Guang
. Rapid identification of parathyroid by fluorescence microsphere immunochromatography[J]. Journal of Surgery Concepts & Practice, 2018
, 23(02)
: 120
-124
.
DOI: 10.16139/j.1007-9610.2018.02.008
[1] 朱利国, 邹贤, 范俊, 等. 甲状旁腺激素荧光免疫层析定量检测技术的研制及应用研究[J]. 现代免疫学,2018,38(1):31-35.
[2] 朱精强. 甲状腺手术中甲状旁腺保护专家共识[J]. 中国实用外科杂志,2015,35(7):731-736.
[3] 沈晓卉, 吕春晖, 陈海珍, 等. 甲状腺癌中央区淋巴结清扫和术后甲状旁腺功能减退[J]. 外科理论与实践,2016,21(4):312-317.
[4] Patel HP, Chadwick DR, Harrison BJ, et al.Systematic review of intravenous methylene blue in parathyroid surgery[J]. Br J Surg,2012,99(10):1345-1351.
[5] 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.
[6] 吕春晖, 陈曦. 术中甲状旁腺保护及术后功能减退的预测和治疗[J]. 外科理论与实践,2016,21(4):338-344.
[7] Falco J, Dip F, Quadri P, et al.Cutting edge in thyroid surgery: autofluorescence of parathyroid glands[J]. J Am Coll Surg,2016,223(2):374-380.
[8] 高文超, 石臣磊, 石铁锋, 等. 甲状腺全切除术中纳米碳混悬注射液对提高甲状旁腺识别及旁腺功能保护作用的研究[J]. 中华普通外科杂志,2016,31(12):1001-1004.
[9] 吕春晖, 陈海珍, 沈晓卉, 等. 纳米碳在双甲全切加双侧中央区淋巴结清扫术中的临床应用[J]. 中华内分泌外科杂志,2017,11(1):34-39.
[10] Liu X, Chang S, Jiang X, et al.Identifying parathyroid glands with carbon nanoparticle suspension does not help protect parathyroid function in thyroid surgery: a prospective, randomized control clinical study[J]. Surg Innov,2016,23(4):381-389.
[11] 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.
[12] 黄海燕, 李浩, 林少建, 等. 甲状腺术中应用抽吸组织测定甲状旁腺激素的临床意义[J]. 中华耳鼻咽喉头颈外科杂志,2013,48(11):934-938.
[13] Kihara M, Miyauchi A, Kontani K, et al.Recovery of parathyroid function after total thyroidectomy: long-term follow-up study[J]. ANZ J Surg,2005,75(7):532-536.
[14] Kihara M, Yokomise H, Miyauchi A, et al.Recovery of parathyroid function after total thyroidectomy[J]. Surg Today,2000,30(4):333-338.
[15] Nussbaum SR, Thompson AR, Hutcheson KA, et al.Intraoperative measurement of parathyroid hormone in the surgical management of hyperparathyroidism[J]. Surgery,1988,104(6):1121-1127.
[16] Bian XH, Li SJ, Zhou L, et al.Applicability of rapid intraoperative parathyroid hormone assay through fine needle aspiration to identify parathyroid tissue in thyroid surgery[J]. Exp Ther Med,2016,12(6):4072-4076.
[17] 李永平, 杨莉, 李南林, 等. 术中穿刺检测鉴别淋巴结与甲状旁腺28例临床研究[J].中国实用外科杂志,2016,36(11):1224-1226.
[18] Qasaimeh GR, Al Nemri S, Al Omari AK.Incidental extirpation of the parathyroid glands at thyroid surgery: risk factors and post-operative hypocalcemia[J]. Eur Arch Otorhinolaryngol,2011,268(7):1047-1051.
[19] 苏艳军, 刘彬, 刁畅, 等. 甲状腺术中甲状旁腺体外保存后自体移植对其功能影响的研究[J].重庆医学,2017,46(8):1032-1035.
[20] 朱精强, 苏安平. 甲状旁腺自体移植的现状及思考[J]. 中华外科杂志,2017,55(8):566-569.
