继发性甲状旁腺功能亢进术中免疫胶体金检测取样方式的应用价值OA

Objective To assess the clinical effectiveness of using immune colloidal gold technique(ICGT)with either fine-needle aspiration or tissue homogenate sampling for intraoperative identification of suspected parathyroid tissue in guiding the surgical treatment of secondary hyperparathyroidism(SHPT).Methods A retrospective analysis was conducted on the clinical data of 64 patients who under-went surgery for SHPT from October 2022 to August 2024 in Second People's Hospital of Hefei.Patients were divided into the fine-needle aspiration group(20 cases),the tissue homogenate group(22 cases),and the intraoperative frozen section group(22 cases)according to the sampling method employed.The levels of biochemical indicators such as parathyroid hormone(PTH),blood calcium(Ca),blood phosphorus(P),alkaline phosphatase(ALP)before and after the operation,surgery-related data such as operation time,intraoperative blood loss,extubation time,symptom relief,occurrence of postoperative complications and parathyroid identification of patients in each group were compared.Results The PTH levels of patients in the fine-needle aspiration group 1 day,3 days and 6 months after the operation were higher than those in the tissue homogenate group and the intraoperative frozen section group,and the differences were statistically significant(P<0.05).Six months after the operation,the levels of serum Ca,P and ALP in the fine-needle aspiration group were all higher than those in the tissue homogenate group and the intraoperative frozen section group,and the differences were statistically significant(P<0.05).Among them,the levels of Ca and ALP remained within the normal range,while the level of P exceeded the upper limit of the normal value.No significant differences were found in postoperative biochemical indicators between the tissue homogenate group and the intraoperative frozen section group(P>0.05).There were no statistically significant differences in the relief of symptoms or occurrence of complications among the three groups(P>0.05).The single-sampling identification time of the intraoperative frozen section group was(32.32±4.98)minutes,which was significantly longer than those of the fine-needle aspiration group[(7.00±1.38)minutes]and the tissue homogenate group[(8.77±0.92)minutes];moreover,the single-sampling identification time of the tissue homogenate group was also longer than that of the fine-needle aspiration group,with statistically significant differences(P<0.01).During the operation,a total of 140 suspicious tissues were excised in the intraoperative frozen section group,89 were orthotopic parathyroid glands,23 were ectopic parathyroid glands,and 28 were lymphoadipose tissues after confirmed.In the identification of ectopic parathyroid glands,the tissue homogenate demonstrated higher sensitivity(91.30%vs.52.17%)and accuracy(94.12%vs.67.65%)than the fine-needle aspiration,with statistically significant difference(P<0.05).Conclusion ICGT combined with tissue homogenate sampling enhances the detection rate of ectopic parathyroid glands.It is not only superior to fine-needle aspiration in terms of sensitivity and accuracy,but also leads to better short-term outcomes and a lower risk of mid-to-long-term recurrence,offering high safety and practicality.