Han Nancy, Bumpous Jeffrey M, Goldstein Richard E, Fleming Muffin M, Flynn Michael B
Division of Surgical Oncology, University of Louisville School of Medicine, Department of Surgery, Louisville, Kentucky, 40202, USA.
Am Surg. 2007 Aug;73(8):820-3.
The objective of this study was to determine the value of intra-operative methylene blue (MB) during parathyroid surgery. We did a retrospective study of 473 patients after initial exploration for previously untreated symptomatic primary hyperparathyroidism. Procedural and post procedural data were collected on four groups of patients: minimally invasive parathyroidectomy with MB (n = 147), and without MB (n = 205), bilateral parathyroid exploration with intra-operative parathormone assay with MB (n = 56), and without MB (n = 65). Length of surgery was shorter for patients explored with MB (P = 0.026). For the minimally invasive parathyroidectomy group, the difference between the MB and non-MB groups was seven minutes. Twelve minutes was the difference between the MB and non-MB intra-operative parathormone assay groups. Length of stay, local complications, and correction of hypercalcemia after parathyroidectomy were not significantly affected by the use of MB. Systemic complications were lower in the MB groups. Aside from a statistically significant, but quantitatively minimal decrease in the length of surgery, no consistent benefit was identified with the use of MB for intra-operative parathyroid identification.
本研究的目的是确定术中亚甲蓝（MB）在甲状旁腺手术中的价值。我们对473例因既往未经治疗的有症状原发性甲状旁腺功能亢进症而初次接受探查的患者进行了一项回顾性研究。收集了四组患者的手术过程及术后数据：使用MB的微创甲状旁腺切除术（n = 147）、未使用MB的微创甲状旁腺切除术（n = 205）、术中使用甲状旁腺激素测定并使用MB的双侧甲状旁腺探查术（n = 56）、术中使用甲状旁腺激素测定但未使用MB的双侧甲状旁腺探查术（n = 65）。使用MB进行探查的患者手术时间较短（P = 0.026）。对于微创甲状旁腺切除术组，使用MB组与未使用MB组的差异为7分钟。使用MB组与未使用MB组的术中甲状旁腺激素测定组差异为12分钟。甲状旁腺切除术后的住院时间、局部并发症及高钙血症的纠正情况未因使用MB而受到显著影响。MB组的全身并发症较少。除了手术时间在统计学上有显著但数量上极小的缩短外，未发现使用MB进行术中甲状旁腺识别有一致的益处。
