[甲状腺切除术中细针穿刺并测定甲状旁腺激素水平]

[Fine-needle aspiration with measurement of parathyroid hormone levels in thyroidectomy].

作者信息

Huang Hai-yan, Li Hao, Lin Shao-jian, Deng Wei-ye, Li Qiu-li, Chen Yan-feng, Yang An-kui, Zhang Quan, Guo Zhu-ming

机构信息

Department of Head and Neck Surgery, Guangzhou Medical University Cancer Institute and University Hospital,Guangdong 510095, China.

Department of Head and Neck Surgery, SUN Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China. Email:

出版信息

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2013 Nov;48(11):934-8.

PMID:24444640

Abstract

OBJECTIVE

Hypoparathyroidism is one of the most serious complications of thyroidectomy. It is important to identify the parathyroid glands during thyroidectomy. In order to find an economic, simple and less traumatic way to identify the parathyroid glands and testify its feasibility, fine-needle aspiration of suspected parathyroid tissue was used to measure the parathyroid hormone (PTH) levels during the surgical procedure.

METHODS

From Nov. 2011 to Apr. 2012, 50 patients were recruited for thyroid surgery in the Sun Yat-sen University Cancer Centre. During surgery, fine-needle aspiration of suspected tissues, including parathyroid gland, thyroid gland, muscle, fat tissue, and lymph node, was performed, the PTH levels were measured. In addition, the tissues above-mentioned were taken to pathological examination. Statistical processing was adopted to determine the sensitivity and specificity of intraoperative fine-needle aspiration with measurement of PTH level in finding the pathology of the parathyroid gland.

RESULTS

There were 237 tissues from 50 patients in total, and 45 of them were certified as the parathyroid glands by pathology. Intra-operative PTH (ioPTH) of the tissues in forty-four cases were higher than 600 ng/L, ioPTH of the tissues in one case was lower than 600 ng/L, and it was 160 ng/L. The highest ioPTH in other cases was 537.7 ng/L. The sensitivity was 97.8%. The specificity was 100%. The difference between the sensitivity and the specificity of two groups was not statistically significant, and P > 0.05. The level of PTH of parathyroid gland were much higher than other tissues, and P < 0.001.

CONCLUSIONS

The level of ioPTH of parathyroid gland were far higher than thyroid, muscle, fat, lymph node. It is an economic, fast and less traumatic way to identify the parathyroid gland by using the fine-needle aspiration of the parathyroid tissue with measurement of PTH levels. The sensitivity and the specificity are high. It can be used in the thyroidectomy to identify the parathyroid glands.

摘要

目的

甲状旁腺功能减退是甲状腺切除术最严重的并发症之一。在甲状腺切除术中识别甲状旁腺很重要。为了找到一种经济、简单且创伤较小的识别甲状旁腺的方法并验证其可行性，在手术过程中采用细针穿刺疑似甲状旁腺组织来测量甲状旁腺激素（PTH）水平。

方法

2011年11月至2012年4月，中山大学肿瘤防治中心招募了50例接受甲状腺手术的患者。手术过程中，对包括甲状旁腺、甲状腺、肌肉、脂肪组织和淋巴结在内的疑似组织进行细针穿刺，测量PTH水平。此外，将上述组织进行病理检查。采用统计学处理来确定术中细针穿刺测量PTH水平在发现甲状旁腺病变方面的敏感性和特异性。

结果

50例患者共有237个组织，其中45个经病理证实为甲状旁腺。44例组织的术中甲状旁腺激素（ioPTH）高于600 ng/L，1例组织的ioPTH低于600 ng/L，为160 ng/L。其他病例中最高的ioPTH为537.7 ng/L。敏感性为97.8%。特异性为100%。两组敏感性和特异性的差异无统计学意义，P>0.05。甲状旁腺的PTH水平远高于其他组织，P<0.001。