CAJ | 학술논문

目的：探讨静脉注射亚甲蓝在继发性甲旁亢手术中定位旁腺的作用。方法：分析25例在本院行手术治疗的SHPT患者，全组患者均进行术前静脉注射亚甲蓝，观察记录术中旁腺染色数目、染色程度等以判断亚甲蓝对旁腺的定位作用，同时监测分析手术前后PTH、生化指标、症状等变化情况以判断手术疗效。结果：本组25例患者经手术切除甲状旁腺总数为101枚，病理均提示甲状旁腺增生，其中24例存在4枚增生旁腺，1例患者存在5枚增生旁腺，其中1枚为上纵隔异位旁腺，剔除该例额外异位旁腺患者后，亚甲蓝甲状旁腺染色率为95.8%（92/96），其中87.5%（21/24）为4枚均染色，8.3%（2/24）为3枚旁腺染色，4.2%（1/24）为2枚染色。术前iPTH（2010.62±1021.22）pg/mL，术后6个月iPTH（24.52±16.12）pg/mL，iPTH显著降低，术前术后比较差异有统计学意义（P<0.05）；术后血钙、血磷水平逐渐降低，术前术后比较差异有统计学意义（P<0.05）。结论：静脉注射亚甲蓝是继发性甲状旁腺功能亢进手术中快速定位增生旁腺及异位旁腺的一种安全、有效且经济的方法。
목적：탐토정맥주사아갑람재계발성갑방항수술중정위방선적작용。방법：분석25례재본원행수술치료적SHPT환자，전조환자균진행술전정맥주사아갑람，관찰기록술중방선염색수목、염색정도등이판단아갑람대방선적정위작용，동시감측분석수술전후PTH、생화지표、증상등변화정황이판단수술료효。결과：본조25례환자경수술절제갑상방선총수위101매，병리균제시갑상방선증생，기중24례존재4매증생방선，1례환자존재5매증생방선，기중1매위상종격이위방선，척제해례액외이위방선환자후，아갑람갑상방선염색솔위95.8%（92/96），기중87.5%（21/24）위4매균염색，8.3%（2/24）위3매방선염색，4.2%（1/24）위2매염색。술전iPTH（2010.62±1021.22）pg/mL，술후6개월iPTH（24.52±16.12）pg/mL，iPTH현저강저，술전술후비교차이유통계학의의（P<0.05）；술후혈개、혈린수평축점강저，술전술후비교차이유통계학의의（P<0.05）。결론：정맥주사아갑람시계발성갑상방선공능항진수술중쾌속정위증생방선급이위방선적일충안전、유효차경제적방법。
Objective:To discuss the effect of utilizing methylene blue infusion (MBI) to identify secondary hyperparathyroidism(SHPT).Method:25 patients of SHPT with the surgical treatment in our hospital were analyzed. All patients received preoperative intravenous injection of methylene blue. The number and degree of the staining parathyroid gland were observed and recorded.Before and after operation,the iPTH,biochemical parameters and symptoms of SHPT were analyzed.Result: In this group,25 patients underwent surgical resection of the parathyroid gland to 101 pieces, and all of the pathological changes showed that parathyroid hyperplasia,24 patients with 4 glands. 1 patient had 5 parathyroid glands and 1 of them as mediastinal ectopic parathyroid gland, then removal the extra 1 patient of ectopic parathyroid gland. The staining rate of parathyroid gland was 95.8%(92/96),87.5% (21/24) of four stained parathyroid glands,8.3%(2/24) of three stained parathyroid glands,4.2%(1/24) of two stained parathyroid glands. Before operation,the mean iPTH was (2010.62±1021.22)pg/mL,after 6 mouths operation the mean iPTH was (24.52±16.12)pg/mL,the difference was statistically significant(P<0.05). The levels of serum calcium and serum phosphorus decreased gradually after the operation, there were statistically significant differences between the preoperative and postoperative(P<0.05).Conclusion:MBI is a safe,readily available,cost-effective and underutilized technique that facilitates rapid identification of hyperplastic glands and helps to locate ectopic glands.