术中穿刺洗脱液甲状旁腺激素检测在继发性甲状旁腺功能亢进术中的应用

Parathyroid hormone assay with eluent of aspirated tissues in parathyroidectomy

目的探讨通过术中细针穿刺(intraoperative fine-needle aspiration,IFNA)组织进行洗脱液甲状旁腺激素(PTH)检测,在甲状旁腺切除术中的应用价值。方法纳入武汉大学中南医院2019年1月至10月收治的54例继发性甲状旁腺功能亢进(SHPT)患者,其中男性24例,女性30例,年龄20~83岁。纳入病例均采取甲状旁腺次全切除伴自体移植的手术方式,术中行IFNA洗脱液PTH检测,同时相对应组织送常规病理检查。通过SPSS及R软件对IFNA洗脱液PTH检测结果和术后病理结果进行比较分析,计算其敏感度、特异度等。结果54例患者均顺利完成手术,除2例无症状患者外,其余患者术后症状均有不同程度的改善,均未出现低钙血症、声音嘶哑等严重并发症。术中共检测了231份组织,根据IFNA洗脱液检测识别为甲状旁腺者为216份,阴性结果为15份;根据术后病理结果,确定为甲状旁腺组织的有217份,非旁腺组织有14份。IFNA洗脱液PTH检测识别甲状旁腺组织敏感度为100.0%,特异度为99.5%。结论IFNA洗脱液PTH测定快速、简单、准确、高效,有助于术者识别甲状旁腺组织。

Objective To explore the values of intraoperative fine-needle aspiration(IFNA)and parathyroid hormone(PTH)detection in the eluate of aspirated tissue during parathyroidectomy.Methods Fifty-four patients with secondary hyperparathyroidism(SHPT)including 24 males and 30 females,aged 20-83 years,admitted to Zhongnan Hospital of Wuhan University from January 2019 to October 2019,were included.All patients received subtotal parathyroidectomy with autologous transplantation,during surgery,IFNA and PTH detection in the eluate of aspirated tissue were performed,and also routine postoperative pathological examination was performed.The results of PTH detection in the eluate of aspirated tissue and postoperative pathological examinations were compared and analyzed by SPSS and R software for evaluating of the sensitivity,specificity,positive predictive value,negative predictive value,misdiagnosis rate,missed diagnosis and accuracy.Results Surgery was completed successfully in all patients.After surgery,the symptoms were improved in the patients except two who were asymptomatic.None had any serious postoperative complications such as hypocalcaemia or hoarseness.A total of 231 aspirated tissue samples were tested,of which 216 were identified as parathyroid and 15 non-parathyroid based on intraoperative PTH detection in tissue eluate;while 217 were confirmed as parathyroid tissues and 14 non-parathyroid tissues with postoperative pathological examinations.The specificity and sensitivity of intraoperative IFNA and PTH detection in tissue eluate for identifying parathyroid tissues were 99.5%and 100.0%,respectively.Conclusion The IFNA and PTH detection in tissue eluate is a rapid,simple,and accurate procedure,which helps the surgeon to identify parathyroid tissue and to ensure the endocrine activity of preserved or autografted parathyroid tissue during parathyroidectomy.