关键词: 甲状腺癌手术, Diff-Quik染色, 血清钙, 甲状旁腺

Abstract: Background and purpose: Thyroid cancer is a common malignant tumor of endocrine system. Radical surgery is an important method for the treatment of thyroid cancer, especially differentiated thyroid cancer. It is of great significance to protect parathyroid gland during operation. In previous studies, rapid detection of intraoperative puncture can accurately identify intraoperative suspicious lymph nodes, which is helpful to the protection and in situ preservation of parathyroid. The purpose of this study was to explore the feasibility of the fine needle puncture Diff-Quik staining for the differentiation and protection of parathyroid glands in thyroid carcinoma surgery. Methods: Clinical data of 40 papillary thyroid cancer patients at Pudong Hospital of Shanghai between Oct. 2018 and Jan. 2020 were collected. The patients were randomly divided into two groups. In the control group, the parathyroid glands were identified with the naked eye by the chief surgeon according to experience. In the experimental group, if suspicious parathyroid gland was encountered during lymph node dissection, the surgeon in charge of the operation performed fine needle puncture on the suspected parathyroid judged by naked eyes, made cell smear, and immediately performed Diff-Quik staining. Blood calcium and parathyroid hormone (PTH) of all the patients were measured on the second day after operation. Blood calcium and PTH were followed up at 1, 3 and 6 months after operation. Results: Using Diff-Quik staining method to quickly diagnose parathyroid glands from the pathological level, could avoid miscutting the parathyroid glands during the operation, and the accuracy rate of parathyroid gland preservation in situ reached 100.0%, which was higher than the accuracy rate (88.2%) of the naked eye to identify parathyroid glands. There was no significant difference in the blood calcium and PTH levels between the patients of the two groups before the operation, 3 months and 6 months after operation (P _1a =0.076, P _2a =0.088, P _1b =0.070, P _2b =0.082); the patients of the two groups were 2 days after the operation and 1 month after the operation. The blood calcium and PTH levels of the patients were lower than those before the operation, the differences were statistically significant (P _3a =0.001, P _4a =0.006, P _3b =0.007, P _4b =0.016). The blood calcium and PTH levels of the experimental group were higher than those of the control group 2 days, 1 month and 3 months after operation (P _5a =0.001, P _6a =0.017, P _5b =0.032, P _6b =0.045). The blood calcium and PTH levels of the control group before and 6 months after the operation were compared with the experimental group, and the differences were not statistically significant (P _7a =0.802, P _8a =0.675, P _7b =0.857, P _8b =0.696). Conclusion: The fine needle puncture Diff-Quik staining could improve the accuracy and specificity of parathyroid differentiation and achieve parathyroid protection.

Key words: Thyroid cancer surgery, Diff-Quik staining, Blood calcium, Parathyroid glands