通过脉管相关标志物表达的对比探讨术中纳米炭甲状旁腺 负显影机制

Mechanism of the "negative development" of carbon nanoparticles for the parathyroid gland in thyroidectomy through expression contrast of vascular-related markers

目的:探讨甲状旁腺淋巴系统的解剖特点与甲状旁腺纳米炭"负显影"的机制。方法:收集昆明医科大学第一附属医院病理科组织标本62例,其中包括正常甲状旁腺组织45例,甲状旁腺腺瘤10例,甲状旁腺癌7例。以正常甲状腺组织10例作为阳性对照,采用淋巴管特异性标志物D2-40、LYVE-1以及血管特异性标志物CD31、CD34对上述标本分别进行免疫组织化学染色,对比鉴别毛细淋巴管与毛细血管。结果:62例甲状旁腺组织中,血管标志物CD31、CD34染色有效例数、阳性例数及阳性率分别为58例、50例、86.2%和60例、60例、100%,阳性者均可见棕黄色的血管呈网状分布。淋巴管标志物D2-40、LYVE-1染色的有效染色例数、阳性例数及阳性率分别为59例、17例、28.8%和58例、23例、39.6%,阳性者仅可见单个或少数棕黄色淋巴管,且多局限性分布于脉管区或被膜区,腺体实质内少见。结论:成年人大部分甲状旁腺可能缺乏淋巴管网,仅部分旁腺存在少数淋巴管,且一般局限分布于被膜区或脉管区,这可能为甲状腺实质内注射纳米炭混悬剂"负显影"甲状旁腺的解剖学机制之一。

Objective： To investigate the anatomical characteristics of the parathyroid lymphatic system and the mechanism of the ＂negative development＂of the carbon nanoparticles for parathyroid gland in thyroidectomy. Methods： This retrospective study used parathyroid tissue samples from patients that were obtained from archival records in the pathology department, including 45 cases of normal parathyroid gland tissues that were accidentally resected in thyroidectomy, 10 cases of parathyroid adenomas, and 7 cases of parathyroid carcinoma. Ten cases of normal thyroid tissues were selected as positive control. Immunohistochemistry was performed using the antibodies specific for lymphatic endothelium, such as D2-40 and LYVE-1, and antibodies specific for vascular endothelial cell such as CD31 and CD34, to distinguish them from each other. Results： A total of 62 parathyroid glands samples were stained with vas- cular markers CD31, CD34 and lymphatic markers D2-40, LYVE-1 respectively （partial samples were stained unsuccessfully）. Vascular vessels in the CD31 staining group were detected in 50 of 58 exam group, positive rate was 100% （60/60）. The positive cells were found ned glands and the positive rate was 86.2%. In the CD34 staining in the central, periphery and vascular hilum of the glands. Howev- er, lymph vessels in the D2-40 staining group were detected from 17 out of 59 examined glands, with the positive rate of 28.8%; In the LYVE-1 staining group, positive rate was 39.6% （23/58）. The positive cells were found in the membrane or vascular hilum, less frequent or undetectable in the central portion. Conclusions： Most of the parathyroid glands of adults might lack a lymphatic network. Only a few adult parathyroid glands had minority lymph vessels, and these lymphatics generally localized at the membrane area or in the vascular hilum, which could be one of the main and anatomical mechanisms resulting in drainage failure or obstruction of carbon nanoparticles and thus in parathyroid ＂negative development.＂