放大成像显示甲状旁腺的内镜基准拍摄距离研究

Fiducial distance for proper amplified endoscopic imaging of parathyroid gland by image 1 HD system

目的确定内镜放大显示甲状旁腺的最适基准拍摄距离。方法2013年4月至2016年3月在浙江大学医学院附属邵逸夫医院头颈外科接受改良Miccoli内镜模式手术的TC患者90例。术中用Image 1 HD内镜系统（德国Karl Storz公司）对甲状旁腺等精细解剖结构进行高清成像观察。以5组基准拍摄距离（1.0、1.5、2.0、2.5及3.0 cm）进行实验观察，通过＂趋近放大显示法＂成像，测得实际甲状旁腺和屏显甲状旁腺尺寸，计算屏显放大倍率。术后对各组间图像放大倍率、清晰程度、稳定性及手术操作可行性进行比较，确定最适基准拍摄距离。结果①基准拍摄距离为3 cm时，可实现甲状旁腺（14.26±3.06（长径））/（12.62±2.88（宽径））倍的屏显图像放大，图像稳定，能对旁腺颜色、轮廓等大致显示；②基准拍摄距离为2.5 cm时，可实现甲状旁腺（16.74±3.15（长径））/（14.81±3.47（宽径））倍的屏显图像放大，图像稳定且对旁腺颜色、轮廓等显示清晰，蒂血管、被膜下血管等显示尚较模糊；③基准拍摄距离为1 cm时，可实现甲状旁腺（27.72±6.45（长径））/（26.33±7.22（宽径））倍的屏显放大倍率，此时，旁腺颜色、轮廓、蒂血管及被膜下小血管等精细结构都能清晰显示，图像晃动明显，画面稳定性差。结论① 2.5 cm是现有内镜系统条件下可进行搜寻、辨识及保护甲状旁腺的最适基准拍摄距离。当需进一步确认，即看清旁腺及其血管细节时，可利用1 cm的基准拍摄距离进行显示。②目前的内镜系统通过合理的基准拍摄距离设置及趋近放大显示法的使用可清晰显示甲状旁腺的细节结构，用于甲状旁腺的辨识和确认。

ObjectiveTo determine a proper fiducial photography distance setting for ideal amplified endoscopic imaging of parathyroid gland by high definition endoscopy system.Methods30 patients were operated with MIVAT mode （modified Miccoli’s approach） for treatment of thyroid carcinoma from Apr. 2013 to Mar. 2014. High definition imaging was established by Image 1 Endoscopy System （Karl Storz Co.） to observe parathyroid gland and related fine anatomical structures during surgery. 5 fiducial photography distances （1.0/1.5/2.0/2.5/3.0 cm） were separately tested during surgery. Maximally amplified parathyroid gland images of each setting were obtained by the ＂approaching-amplifying photographic method＂ , and then the size of the real parathyroid glands as well as their screen images were measured and recorded to calculate the magnification. A proper fiducial photography distance setting was determined postoperatively by comparison of the magnification times, as well as clarity, stability of the imaging and surgical maneuverability.Results①90 parathyroid glands were successfully observed and measured. ② At the longest fiducial photography distance （3.0 cm） , the parathyroid gland could be stably magnified by 14.26±3.06 （long trail） /12.62±2.88 （wide trail） times, but their contour and color not clear.③At the intermediate distance （2.5 cm） , the parathyroid gland could be magnified by 16.74±3.15 （long trail） /14.81±3.47 （wide trail） times with the graphics stable, and the color and contour more clear, but the vascular pedicle and the tiny vessels under the capsule still blurred.④At the shortest distance （1.0 cm） , the parathyroid gland could be magnified by 27.72±6.45 （long trail） /26.33±7.22 （wide trail） times, not only the color and contour, but also the vascular pedicle and the tiny vessels under the capsule of the gland became further clearer, unfortunately the graphics was shimmy and unstable.Conclusions①2.5 cm can be a proper fiducial photography distance for searching, identifying and preserving parathyroid gland in MIVAT, while 1.0 cm can be a special fiducial photography distance for further confirming parathyroid gland when necessary. ② Current high definition endoscopy system can be applied to identify the parathyroid gland if fiducial photography distance was properly set and＂approaching-amplifying photographic method＂was used. Along with the magnification of the imaging, the features of the parathyroid gland may become clearer, including its yellow-brown color and oval contour, as well as the detail structures such as the tiny vessels under the capsule and the vascular pedicle.