PDF(Pubmed)
Abstract：
Hypoparathyroidism is the most frequent complication in thyroid surgery. The aim of this study was to evaluate the impact of intraoperative parathyroid gland identification, using autofluorescence imaging, on the rate of post-operative (PO) hypoparathyroidism in thyroid cancer surgery. Patients undergoing total thyroidectomy with central neck dissection from 2018 to 2022 were included. A prospective cohort of 77 patients operated on using near-infrared autofluorescence (NIRAF+) with the Fluobeam® (Fluoptics, Grenoble, France) system was compared to a retrospective cohort of 94 patients (NIR-). The main outcomes were the rate of PO hypocalcemia, with three cutoffs: corrected calcium (Cac) < 2.10 mmol/L, <2.00 mmol/L and <1.875 mmol/L, and the rate of permanent hypoparathyroidism, at 12 months. The rate of PO Cac < 2.10 mmol/L was statistically lower in the NIRAF+ group, compared to the control group (36% and 60%, p = 0.003, respectively). No statistically significant difference was observed for the other two thresholds. There was a lower rate of permanent hypoparathyroidism in the NIRAF+ group (5% vs. 14% in the control group), although not statistically significant (p = 0.07). NIRAF is a surgically non-invasive adjunct, and can improve patients\' outcomes for thyroid cancer surgery by reducing post-operative temporary hypoparathyroidism. Larger prospective studies are warranted to validate our findings.
摘要：
甲状旁腺功能减退症是甲状腺手术中最常见的并发症。这项研究的目的是评估术中甲状旁腺识别的影响，使用自发荧光成像，甲状腺癌手术后甲状旁腺功能减退率。纳入2018年至2022年接受中央颈清扫术的甲状腺全切除术患者。前瞻性队列研究77例患者使用近红外自发荧光（NIRAF+）与荧光®（Fluopthics，格勒诺布尔,法国)系统与94名患者的回顾性队列(NIR-)进行了比较。主要结果是PO低钙血症的发生率，具有三个截止值：校正钙（Cac）<2.10mmol/L，<2.00mmol/L和<1.875mmol/L，和永久性甲状旁腺功能减退症的发生率，在12个月。NIRAF+组POCac<2.10mmol/L的发生率明显低于对照组,与对照组相比（36%和60%，分别为p=0.003)。其他两个阈值没有观察到统计学上的显著差异。NIRAF+组中永久性甲状旁腺功能减退症的发生率较低（5％vs.对照组为14%)，虽然没有统计学意义（p=0.07）。NIRAF是一种非侵入性手术辅助药物,可以通过减少术后暂时性甲状旁腺功能减退症来改善甲状腺癌手术患者的预后。有必要进行更大的前瞻性研究来验证我们的发现。
