亚甲蓝喷雾在甲状腺切除术中识别甲状旁腺的敏感性和特异性。

The sensitivity and specificity of methylene blue spray to identify the parathyroid gland during thyroidectomy.

作者信息

Piromchai Patorn, Juengtrakool Thipphailin, Laohasiriwong Supawan, Kasemsiri Pornthep, Ungarereevittaya Piti

机构信息

Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

出版信息

PeerJ. 2019 Jan 23;7:e6376. doi: 10.7717/peerj.6376. eCollection 2019.

DOI:10.7717/peerj.6376

PMID:30697498

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6347963/

Abstract

BACKGROUND

Hypocalcemia is a common complication of thyroidectomy resulting from an injury to the parathyroid gland. Methylene blue, which is a medication and dye that has been used for more than a century, is safe and readily available. The previous study has found that methylene blue spray on the surgical field is absorbed by the parathyroid gland faster than in the perithyroidal area. This study was aimed to evaluate the diagnostic value of methylene blue spray to identify the parathyroid gland during thyroid lobectomy.

METHODS

Patients who underwent thyroid lobectomy were recruited. After the recurrent laryngeal nerve was identified, methylene blue was sprayed onto the thyroid bed. After 5 min, the thyroid bed was inspected for areas in which the blue color had been rapidly absorbed. Biopsies were conducted for histopathology at both the stained area and the area in which the color had faded. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.

RESULTS

A total of 47 patients participated in this study. The sensitivity of methylene blue spray to identify the parathyroid gland during thyroid lobectomy was 92.31% (95% CI [63.97-99.81]) and specificity was 56.79% (95% CI [45.31-67.76]). The PPV was 25.53% (95% CI [20.34-31.53]) and NPV was 97.87% (95% CI [87.39-99.67]). There were no patients with post-operative hypocalcemia, allergic reactions to the methylene blue, or methylene blue toxicity.

CONCLUSION

The methylene blue spray could serve as a screening tool for identification of the parathyroid gland.

摘要

背景

低钙血症是甲状腺切除术后因甲状旁腺损伤导致的常见并发症。亚甲蓝作为一种药物和染料已使用了一个多世纪，安全且易于获取。先前的研究发现，手术野上喷洒的亚甲蓝被甲状旁腺吸收的速度比甲状腺周围区域更快。本研究旨在评估亚甲蓝喷洒在甲状腺叶切除术中识别甲状旁腺的诊断价值。

方法

招募接受甲状腺叶切除术的患者。在识别出喉返神经后，将亚甲蓝喷洒在甲状腺床。5分钟后，检查甲状腺床中蓝色迅速吸收的区域。对染色区域和颜色已褪去的区域进行活检以进行组织病理学检查。计算敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。

结果

共有47名患者参与本研究。亚甲蓝喷洒在甲状腺叶切除术中识别甲状旁腺的敏感性为92.31%（95%CI[63.97 - 99.81]），特异性为56.79%（95%CI[45.31 - 67.76]）。PPV为25.53%（95%CI[20.34 - 31.53]），NPV为97.87%（95%CI[87.39 - 99.67]）。没有患者出现术后低钙血症、对亚甲蓝的过敏反应或亚甲蓝毒性。