The Study Of The Role Of Methylene Blue In The Localization Of Parathyroid Glands In The Operation Of Secondary Hyperparathyroidism

ObjectiveThrough the prospective controlled clinical trial, we will explore the role of methylene blue positive development in the localization of parathyroid glands in total parathyroidectomy, offer a fast, safe and effective method of locating parathyroid in patients with secondary hyperthyroidism for clinical surgical operation, so as to improve the success rate of surgery, ensure the safety of surgery, shorten the operation time, reduce the intraoperative and postoperative complications.Method49 cases of secondary hyperparathyroidism patients who would undergo total parathyroidectomy with autotransplantation in Guangdong Province Traditional Chinese Medical Hospital were screened according to the diagnostic criteria, inclusion criteria, exclusion criteria. They were assigned into two groups according to the admission number:the experimental group which was intravenous dripped methylene blue, and the control group without any developing method. There were 25 cases in the experimental group and 24 cases in the control group. The operation time, success rate of operation, incidence of adverse reactions, the detection rate and positive predictive value of parathyroid gland were compared between the two groups.Achievements1.The staining time and degree were significantly different between parathyroid and thyroid. When the thyroid has faded, the parathyroid still blue dye. Thyroid and parathyroid were stained blue, the former was osteoporotic light blue, the latter was dense blue.2. The operation time of the two groups is (94.92+13.55), (138.21+45.54) min respectively, the operation time of the experimental group was shorter than that of the control group, the difference was statistically significant (rank sum test, Z=-4.90, P＜0.01).3. Among the 25 patients in the experimental group,24 cases (24/25,96%) had a successfully operation. There were 24 patients in the control group, of these,18 cases (18/24,75%) had a successfully operation.The success rate of the experimental group was higher than that of the control group, the differences were statistically significant(Fisher exact test, P=0.05).4. The detection rate of the two groups were 99.00%and 92.86% respectively, the difference was statistically significant(Fisher exact test, P=0.03). The positive predictive values of the two groups were 97.06%and 91.92%respectively, the difference have not statistical significance(x2 test,x2=2.57,P=0.13).5. The detection rate of the ectopic parathyroid of the two groups were 80%、50%respectively, methylene blue staining is easy to find the ectopic parathyroid in the thyroid, mediastinum, carotid sheath.6. Adverse reactions associated to methylene blue occurred in 1 patients of the experimental group (4%,1/25), one patient vomited.The vomitus is blue gastric contents, the difference of the incidence rate of adverse reaction was not statistically significant(Fisher exact test, P=1.00).ConelusionIn parathyroidectomy of secondary hyperparathyroidism patients, methylene blue positive development can quickly, safely and effectively locate the parathyroid gland, especially can easy to find ectopic parathyroid gland, it is worth of clinical application.