目的 探讨纳米碳甲状旁腺淋巴负显影技术在慢性肾脏病(CKD)继发性甲状旁腺功能亢进症(SHPT)患者手术中的应用价值.方法 选择2014年6月至2015年12月该中心收治的CKD 5期SHPT患者20例,利用纳米碳混悬液局部注射结合术前甲状旁腺B超、颈部增强CT及99Tcm-甲氧异晴双时相扫描(MIBI)甲状旁腺核素显像定位诊断和术中血清全段甲状旁腺激素(iPTH)快速测定,行甲状旁腺切除术(PTX)及自体前臂移植术.结果 纳米碳悬注射液后甲状腺及淋巴结迅速黑染,而目标甲状旁腺则不显色、呈肉色或淡黄色,术中视野清楚,快速剥离甲状旁腺,手术损伤小;术后血钙、血磷、血iPTH明显下降,随访至术后6个月,术前术后血钙、血磷、血碱性磷酸酶、血iPTH水平比较差异有统计学意义(P＜0.05).术后患者骨痛、肌痛、皮肤瘙瘁症状明显缓解,随访时间内20例患者无复发及癌变.结论 纳米碳混悬液示踪剂在CKD 5期SHPT患者行PTX中能够对甲状旁腺做到实时、精准的切除,可于临床推广应用.%Objective To explore the application value of nanocarbon parathyroid lymph negative development technique in the operation of the patients with chronic kidney disease(CKD) secondary hyperparathyroidism(SHPT).Methods Twenty cases of CKD stage 5 SHPT in our center from June 2014 to December 2015 were treated by parathyroidectomy(PTX) and forearm autotransplantation,using nanocarbon suspension local injection combined with preoperative parathyroid ultrasonography,enhanced CT and neck 99Tcm-MIBI and iPTH rapid determination.Results Thyroid and lymph node were quickly dyed black after nanocarbon suspension injection,while the target parathyroid did not develop with flesh color or pale yellow,clear vision in operation,fast stripping parathyroid and small surgical injury;postoperative serum calcium,phosphorus and iPTH were decreased significantly,postoperative follow-up lasted for 6 months,serum calcium,phosphorus,alkaline phosphatase and iPTH had statistically significant differences between before and after operation(P＜0.05).The symptoms of pain,myalgia and pruritus after operation were significantly relieved,and 20 cases had no reccurrence during follow up period.Conclusion The nanocarbon mixed suspension tracer agent can achieve real-time and accurate resection in the PTX of the patients with CKD stage 5 SHPT and can be used in clinic.
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