腺體內(nèi)注射亞甲藍(lán)在甲狀腺術(shù)中辨別保護(hù)甲狀旁腺的應(yīng)用研究

陳華鋒 江志遠(yuǎn) 吳登東

[摘要] 目的 探討腺體內(nèi)注射亞甲藍(lán)在甲狀腺術(shù)中辨別保護(hù)甲狀旁腺的應(yīng)用價(jià)值。方法 方便選取2015年1月—2019年1月該院232例甲狀腺手術(shù)患者隨機(jī)分為兩組，亞甲藍(lán)組應(yīng)用腺體注射亞甲藍(lán)辨別保護(hù)甲狀旁腺，對(duì)照組為常規(guī)甲狀腺手術(shù)，對(duì)兩組甲狀腺手術(shù)患者臨床資料進(jìn)行分析。 結(jié)果 全組患者均康復(fù)出院，亞甲藍(lán)組病理檢查發(fā)現(xiàn)2枚發(fā)生甲狀旁腺誤切，發(fā)生率為1.79%，對(duì)照組病理檢查發(fā)現(xiàn)有8枚甲狀旁腺誤切，發(fā)生率為6.67%，統(tǒng)計(jì)分析兩組差異有統(tǒng)計(jì)學(xué)意義（χ2=3.35，P<0.05）。暫時(shí)性甲狀旁腺功能減退亞甲藍(lán)組發(fā)生率為4.46%，對(duì)照組發(fā)生率11.67%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（χ2=3.99，P<0.05）。 結(jié)論 腺體內(nèi)注射亞甲藍(lán)在甲狀腺術(shù)中辨別保護(hù)甲狀旁腺有一定的臨床應(yīng)用價(jià)值，具有可行性和安全性，經(jīng)濟(jì)簡(jiǎn)便。

[關(guān)鍵詞] 甲狀腺;甲狀旁腺;外科手術(shù);亞甲藍(lán)

[中圖分類(lèi)號(hào)] R4? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1674-0742（2019）08（c）-0083-03

[Abstract] Objective To investigate the value of intra-gland injection of methylene blue in the prevention of parathyroid glands in thyroid surgery. Methods From January 2015 to January 2019， 232 patients with thyroid surgery were convenient divided into two groups. The methylene blue group was treated with glandular injection of methylene blue to protect the parathyroid glands. The control group was treated with conventional thyroid surgery. The clinical data of patients with thyroid surgery were analyzed. Results All patients were discharged from the hospital. The pathological examination of the methylene blue group found that two parathyroid glands were miscut， the incidence rate was 1.79%， and the pathological examination of the control group found that 8 parathyroid glands were miscut， and the incidence rate was 6.67%， and there was a significant difference between the two groups （χ2=3.35， P<0.05）. The incidence of transient hypoparathyroidism was 4.46% in the methylene blue group and 11.67% in the control group. There was a significant difference between the two groups （χ2=3.99， P<0.05）. Conclusion Intramuscular injection of methylene blue has certain clinical application value in the protection of parathyroid glands in thyroid surgery. It is feasible， safe and economical.

[Key words] Thyroid; Parathyroid gland; Surgery; Methylene blue

甲狀腺疾病是臨床常見(jiàn)，手術(shù)治療是重要的手段，但手術(shù)并發(fā)癥并不少見(jiàn)，其中甲狀旁腺地?fù)p傷仍然難以避免，常導(dǎo)致不良后果，臨床上通過(guò)精細(xì)化解剖操作和各種示蹤劑幫助提高甲狀旁腺的辨識(shí)，其中亞甲藍(lán)一般用作靜脈注射作為正顯影保護(hù)技術(shù)[1]，該組病例探討使用甲狀腺術(shù)中腺體實(shí)質(zhì)內(nèi)注射亞甲藍(lán)，通過(guò)負(fù)顯影辨別保護(hù)甲狀旁腺，取得一定的臨床療效，收集2015年1月—2019年1月收治患者232例，現(xiàn)報(bào)道如下。

1? 資料與方法

1.1? 一般資料

方便選取的該組232例甲狀腺手術(shù)入組患者均為首次手術(shù)患者，手術(shù)方式為單側(cè)或雙側(cè)甲狀腺次全、近全或全切。隨機(jī)分成兩組，亞甲藍(lán)組應(yīng)用腺體注射亞甲藍(lán)辨別保護(hù)甲狀旁腺，對(duì)照組為常規(guī)甲狀腺手術(shù)，亞甲藍(lán)組112例，男45例，女67例，年齡20～76歲，中位年齡44歲;臨床診斷為結(jié)節(jié)性甲狀腺腫58 例，甲狀腺機(jī)能亢進(jìn)36例，慢性甲狀腺炎3例，甲狀腺瘤7例，甲狀腺乳頭狀癌8例?！?br>