| Objective:By comparing and studying different chronic kidney disease secondary hyperparathyroidism(SHPT)patients in the operation of nano-carbon negative development localization,intraoperative nerve monitoring technology to explore whether the rapid positioning of the parathyroid gland,complete removal of the parathyroid Whether the gland can reduce postoperative complications such as hoarseness.In order to reduce medical risks,ensure the quality of medical care,provide new ideas for the thoroughness and safety of surgery,and achieve the purpose of controlling the quality control of surgical treatment of SHPT.Methods:A review of 50 patients diagnosed with SHPT by thyroid surgery in the first affiliated hospital of chengdu medical college from December 2016 to December 2018.Collecting 25 people in the nano-carbon group,using conventional parathyroidectomy + autograft + nano-carbon negative development + intraoperative nerve monitoring technology;Twenty-five non-nano-carbon group were collected and treated with parathyroidectomy + autograft.SPSS22.0 statistical software was used to compare the analysis of operation time,intraoperative blood loss,number of parathyroidectomy,blood iPTH,calcium and phosphorus reduction,and recurrent laryngeal nerve injury rate before and after surgery.Results:(1)There was no significant difference in age,gender,preoperative blood iPTH,serum phosphorus and serum calcium between the two groups(P>0.05).There was comparability between the two groups.(2)In the nano-carbon group,the thyroid and the pre-neck IV lymph nodes were rapidly black-stained after the thyroid was injected with the nano-carbon suspension,while the parathyroid glands were not black-stained and were quickly found.The intraoperative nerve monitoring can be based on the waveform and amplitude.Identify and determine the recurrent laryngeal nerve.(3)There was a statistically significant difference in the number of parathyroidectomy between the two groups(t=4.234,P<0.01).There was a statistically significant difference between the two groups(t=3.510,P<0.05).A total of 105 parathyroid glands were removed from the nano-carbon group,with an average of 4.2±0.41 per patient.The postoperative hospital stay was 6.68±2.77 days.The non-nanocarbon group co-excised 90 parathyroid glands,with an average of 3.6±0.58 per patient.The postoperative hospital stay was 9.76±3.39 days.(4)The operation time and intraoperative blood loss of the nano-carbon group were less than that of the non-nano carbon group(P<0.01).The operation time of the nano-carbon group and the non-nano-carbon group was 82.93±15.16 min and 154.19±14.17 min respectively.The amount of bleeding in the middle was 16.26±4.08 ml and 25.03±3.23 ml,respectively.(5)There was nosignificant difference in postoperative complications between the two groups(P>0.05).The incidence of transient hypocalcemia in the nanocarbon group and non-nano carbon group was 68%(17/25)and 56%(14/25),respectively.The nano-carbon group RLN has a temporary injury rate of4%(1/25)and a permanent injury rate of 0.The non-nano carbon group RLN temporary injury rate was 12%(3/25),and the permanent injury rate was 0.(6)The blood iPTH of the nano-carbon group was significantly lower than that of the non-nanocarbon group at 20 min,3 d,and 7 d after surgery(P<0.05).The blood iPTH was 2072.12±336.66 pg/ml,256.36±102.37 pg/ml,72.52±16.76 pg/ml,and 84.54±18.52 pg/ml before and after operation at 20 min,3 d,and 7 d.The non-nano carbon group was 1748.68±405.05 pg/ml,679.66±330.54 pg/ml,203.83±47.18 pg/ml,and 179.91±18.70pg/ml,respectively.Conclusion:TPTX+AT has important parathyroid localization value through intraoperative application of nano-carbon negative development technology,which significantly improves the resection rate of parathyroid glands.Intraoperative nerve monitoring combined with nano-carbon negative development can reduce the operation time and intraoperative the amount of bleeding.However,there was no statistically significant difference in intraoperative neurological monitoring techniques in reducing the incidence of recurrent laryngeal nerve injury. |
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