| Objective: By comparison and analysis preoperative and postoperative related indicators of the Control group(group A),Methylene blue group(group B),Nano carbon group(group C)and Fine-needle aspiration rapid intraoperative parathyroid hormone(r IO-PTH)group(group D).To further explore whether r IO-PTH has a certain value for the intraoperative identification and protection of the parathyroid glands,and reduce the damage rate of the parathyroid glands.Reduce the incidence of hypoparathyroidism and hypocalcemia in postoperative.Improve the quality of life of patients with thyroidectomy,and provide an effective and rapid method for the identification and protection of parathyroid glands in the future thyroidectomy.Methods: In this study,a total of 140 patients who underwent total thyroidectomy due to thyroid diseases were admitted to our hospital from August 2017 to February 2019.According to different intraoperative intervention methods,the patients were divided into group A,group B,group C and group D,with 35 cases in each group.In group D,the thyroid was separated intraoperatively.The suspected parathyroid tissues were searched according to the anatomical location,and the tissue fluid was aspirated by FNA.The concentration of r IO-PTH was determined by the detection of parathyroid hormone(PTH),so as to identify the parathyroid gland.In group C and group B,respectively,Nano carbon and Methylene blue were injected into the thyroid during the operation,and parathyroid gland was identified and thyroid surgery was performed after the thyroid and surrounding lymph nodes were completely stained.In group A,thyroid surgery was performed only in the traditional way.Comparative analysis of gender,age,preoperative PTH and serum calcium,numbers of intraoperative identification of parathyroid glands,postoperative 1st,4th,7th and 30 th PTH and serum calcium,the incidence of hypoparathyroidism and hypocalcemia in postoperative.SPSS22.0 statistical software was used to conduct chisquare test,variance analysis(F test)and q test on the results,to explore whether there were statistical differences among the groups.Results: Surgery in all four groups was successfully completed without significant adverse reactions.Statistical analysis of age,gender,preoperative serum calcium and PTH levels in the four groups showed no significant difference in each group(P<0.05),and there was comparability between the four groups.During the operation,the parathyroid glands were identified.The average of group A was 2.6?0.3,the average of group B was(2.8?0.4),the average of group C was(3.1?0.3),and the average of group D was(3.0?0.2).There was a statistically significant difference in the average number of parathyroid glands between the 4 groups(P<0.05).Pairwise comparison among the four groups show that there was no significant difference between group C and group D(P > 0.05),but there were significant statistical differences between the other groups(P<0.05).Postoperative serum calcium levels were decreased in all the four groups,and there were statistical differences(P < 0.05)on the first,4th,7th and 30 th day after surgery.The serum calcium level in group A decreased more significantly than before.Pairwise comparison of serum calcium levels at four postoperative time points showed that on the 1st,4th,7th and 30 th day after surgery,serum calcium levels in group A were significantly lower than those in group B,C and D,and there were statistical differences(P < 0.05).The serum calcium levels in group B,C and D were lower than before,but there was no significant difference in serum calcium levels between the three groups on the 1st and 30 th days after operation(P > 0.05).On the 4th and 7th days after surgery,serum calcium levels in group B was lower than that in group C、D,and the difference was statistically significant(P < 0.05).Serum calcium levels of group C and group D at four time points after surgery were compared,the difference was not statistically significant(P > 0.05).The PTH levels of the four groups decreased after operation.The PTH levels of the four groups on the 1st,4th,7th and 30 th days after operation were compared,the difference was statistically significant(P < 0.05).The PTH levels of group A decreased more significantly than before.Pairwise comparison of PTH levels at 4 time points after surgery in the four groups showed that PTH levels in group A were significantly lower than those in group B,C and D at 1st,4th,7th and 30 th days after surgery,the difference was statistically significant(P < 0.05).On the 1st,4th and 7th day after operation,PTH levels in group B was lower than that in group C and D,with significant difference(P < 0.05).However,on the 30 th day after surgery,PTH levels in groups B,C and D were compared,and the difference was not statistically significant(P > 0.05).PTH levels of group C and group D at 4 postoperative time points were compared,the difference was not statistically significant(P > 0.05).The incidence of postoperative hypocalcemia was 28.6%(10/35)in group A,8.6%(3/35)in group B,5.7%(2/35)in group C,and 8.6%(3/35)in group D.The incidence of postoperative hypothyroidism was 37.1%(13/35)in group A,14.3%(5/35)in group B,11.4%(4/35)in group C,and 14.3%(5/35) in group D.The incidence of hypocalcemia and hypothyroidism in the four groups was significantly higher in group A than in group B,C and D,and the difference was statistically significant(P < 0.05).Pairwise comparison of hypocalcemia and hypothyroidism after surgery in the four groups showed that significant differences between group A and group B,C and D(P < 0.05).There was no significant difference among groups B,C and D(P > 0.05).Conclusion: Fine-needle aspiration(FNA)rapid intraoperative detection of parathyroid hormone(r IO-PTH)can identify parathyroid tissue.During total thyroidectomy,r IO-PTH can significantly reduce the excessive reduction of postoperative serum calcium and PTH levels in patients,which can effectively reduce the incidence of postoperative hypocalcemia and parathyroid hypofunction complications.r IO-PTH has high clinical application value in identifying and protecting parathyroid gland in thyroid surgery. |
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