纳米炭甲状旁腺负显影技术在慢性肾脏病SHPT患者手术中的应用研究

Application of nano carbon parathyroid negative imaging in operation on patients with chronic kidney disease secondary hyperparathyroidism

目的探讨纳米炭甲状旁腺负显影技术在慢性肾脏病(CKD)继发性甲状旁腺功能亢进(SHPT患者手术中的应用价值。方法将40例SHPT患者随机分为两组,治疗组20例术中采用甲状腺局部注射纳米炭混悬注射液寻找甲状旁腺,行甲状旁腺切除术(PTX)及自体前臂移植术。对照组20例行PTX及自体前臂移植术。结果纳米炭混悬注射液注射后甲状腺及淋巴结迅速黑染,而目标甲状旁腺则不显色,术中视野清楚,快速剥离甲状旁腺。治疗组平均手术时间为(60. 28±10. 50) min,明显短于对照组的(120. 35±13. 50) min,差异有统计学意义(P <0. 01)。治疗组平均住院时间为(7. 21±2. 20) d,短于对照组的(10. 25±3. 15) d,差异有统计学意义(P <0. 01)。两组术后患者骨痛及皮肤瘙痒症状消失。与术前比较,术后血全段甲状旁腺激素(i PTH)显著下降,但两组比较差异无统计学意义(P> 0. 05)。结论纳米炭混悬注射液在SHPT患者行PTX中有重要的定位价值,可缩短手术时间,减少创伤,缩短住院时间,值得临床推广应用。

Objective To explore the application of nano carbon parathyroid negative imaging in operation on patients with chronic kidney disease( CKD) secondary hyperparathyroidism( SHPT). Methods Forty SHPT patients were randomly divided into two groups. The treatment group( n = 20) was injected with carbon nanoparticles in the thyroid gland to find parathyroid glands,and underwent parathyroidectomy( PTX) and autologous forearm transplantation. The control group( n = 20) underwent PTX and autologous forearm transplantation. Results The thyroids and lymph nodes were quickly dyed black after injection of carbon nanoparticles suspensions,while the targeted parathyroids were not colored. The intraoperative fields were clear and parathyroids were rapidly stripped and dissected.The average time of operation in the treatment group( 60. 28 ± 10. 50) min was significantly shorter than that in the control group( 120. 35 ± 13. 50) min( P < 0. 01). The average hospitalization time of the treatment group( 7. 21 ± 2. 20) days was significantly shorter than that of the control group( 10. 25 ± 3. 15) days( P < 0. 01). The ostalgia and pruritus symptoms disappeared after operation in the two groups,and the postoperative blood i PTH decreased significantly after surgery,but there were no significant differences between the two groups( P > 0. 05). Conclusion The carbon nanoparticles suspension injection has significant positioning value in the PTX of SHPT patients,which can shorten the operation time,reduce the trauma,and shorten the time of hospitalization.