摘要
目的:探讨术中快速鉴别并保护甲状旁腺的新方法。方法:选择2017年7月至2017年8月期间西京医院收治的11例初诊甲状腺癌患者纳入研究。预期进行甲状腺全切及中央区淋巴结清扫的甲状腺癌患者知情同意后进入研究。术中进行淋巴结清扫,遇到可疑的甲状旁腺时,首先由手术主刀医生按照经验主观判断,判断为甲状旁腺或非甲状旁腺并予以记录。接下来对可疑甲状旁腺进行甲状旁腺示踪,根据甲状旁腺素(PTH)含量确定是否为甲状旁腺。最后将可疑甲状旁腺少量取材送快速冰冻病理,以冰冻病理结果作为金标准对比医师肉眼判断以及术中PTH,探讨可疑甲状旁腺的鉴别诊断意义。结果:手术过程中,临床医生共发现21个可疑组织(20个可疑甲状旁腺,1个可疑非甲状旁腺),冰冻病理检测有1个结节因取材不足无法进行检测,剩余20个可疑甲状旁腺经冰冻病理检测确定其性质。以冰冻病理结果为金标准,肉眼经验性评判准确率为60.0%,敏感性为100%,特异性为11.1%,kappa值为0.121,AUC面积仅为0.554;而PTH快速检测准确率为85.0%,敏感性为100%,特异性为66.7%,kappa值为0.688,AUC面积为0.914。结论:术中PTH快速检测可有效提高甲状旁腺鉴别的准确性与特异性,有助于甲状旁腺的保护及原位保留。
Objective：To explore a new method for intraoperative identificattion of parathyroid glands. Methods： Eleven patients admitted to our hospital from July 2017 to August 2017 were enrolled into the study. During lymph node dissection, the suspicious glands were justified firstly by clinician, and then identified by PTH rapid detection method. Finally, frozen pathology outcome proceeded and regarded as golden standard. The diagnostic value was evalu- ated and compared between clinician jusice and PTH detetection. Results ：Twenty -one suspicious parathyroid glands were found by clinician. Except for one node failed for frozen pathology detection becasuse of insufficient sample, the remaining 20 glands were identified their characteristics. Statistical analysis showed that the accuracy, sensitivity and specificity rate, between experimental judgement and PTH detection, were 60.0% vs 85.0% , 100% vs 100% and 11.1% vs 66.7%. Consistency analysis demonstrated that the kapaa value was 0. 121 vs 0. 688,AUC area was 0. 554 vs 0.914. Conclusion： Intraoperative PTH detection method improved the accuracy and specificity of parathyroid identification and may play significant role in the in -situ protection of parathyroid glands.
出处
《现代肿瘤医学》
CAS
2018年第8期1194-1197,共4页
Journal of Modern Oncology
基金
陕西省社会发展科技攻关项目(编号:2016SF-298)
西京医院助推项目(编号:XJZT15Z09)
关键词
甲状腺癌
甲状旁腺
术中保护
快速检测
thyroid carcinoma, parathyroid gland, intraoperative protection, rapid detection
