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Abstract：
BACKGROUND: The added benefit of using near-infrared autofluorescence (NIRAF) during total thyroidectomy (TT) remains controversial. This study investigated whether or not NIRAF results in improved patient outcomes postoperatively.
METHODS: We analyzed 1711 TT patients, reported in nine randomized controlled trials, following a systematic search of five databases. NIRAF was compared to the standard of care (naked eye with/without white light). Outcomes included parathyroid gland (PG) and calcium parameters and other clinical outcomes. For dichotomous outcomes, the log odds ratio (logOR) was calculated, and for continuous outcomes, the crude mean difference (MD) was measured. Sensitivity analysis was performed when heterogeneity was significant. The revised Cochrane risk of bias tool was used to assess the methodological quality.
RESULTS: Compared to the standard of care, the use of NIRAF was associated with a significant reduction in postoperative hypoparathyroidism [logOR=-0.31; 95% CI: -0.57: -0.05], inadvertent PG removal [logOR=-0.93; 95% CI: -1.60: -0.26], and postoperative hypocalcemia [logOR=-0.43 mmol/l; 95% CI: -0.77: -0.09]. It was also associated with significantly higher postoperative PTH levels [MD=4.78 pg/ml; 95% CI: 2.13: 7.43], PG identification rate [logOR=1.02; 95% CI: 0.31: 1.72], postoperative serum calcium [MD=0.05; 95% CI: 0.00: 0.09], and operative time [MD=9.38 min; 95% CI: 6.68: 12.09]. No difference was seen regarding PG autotransplantation, length of hospital stay, and hospitalization due to hypocalcemia. Seven trials had low risk and the remainder had some concerns.
CONCLUSIONS: NIRAF is superior to the naked eye in identifying all four PGs during TT. The reduced risk of postoperative hypoparathyroidism and hypocalcemia reflected this preservation value. However, it was not associated with a change in the length of hospital stay. Although rare, the readmission rate due to hypocalcemia was similar across both methods.
METHODS: We analyzed 1711 TT patients, reported in nine randomized controlled trials, following a systematic search of five databases. NIRAF was compared to the standard of care (naked eye with/without white light). Outcomes included parathyroid gland (PG) and calcium parameters and other clinical outcomes. For dichotomous outcomes, the log odds ratio (logOR) was calculated, and for continuous outcomes, the crude mean difference (MD) was measured. Sensitivity analysis was performed when heterogeneity was significant. The revised Cochrane risk of bias tool was used to assess the methodological quality.
RESULTS: Compared to the standard of care, the use of NIRAF was associated with a significant reduction in postoperative hypoparathyroidism [logOR=-0.31; 95% CI: -0.57: -0.05], inadvertent PG removal [logOR=-0.93; 95% CI: -1.60: -0.26], and postoperative hypocalcemia [logOR=-0.43 mmol/l; 95% CI: -0.77: -0.09]. It was also associated with significantly higher postoperative PTH levels [MD=4.78 pg/ml; 95% CI: 2.13: 7.43], PG identification rate [logOR=1.02; 95% CI: 0.31: 1.72], postoperative serum calcium [MD=0.05; 95% CI: 0.00: 0.09], and operative time [MD=9.38 min; 95% CI: 6.68: 12.09]. No difference was seen regarding PG autotransplantation, length of hospital stay, and hospitalization due to hypocalcemia. Seven trials had low risk and the remainder had some concerns.
CONCLUSIONS: NIRAF is superior to the naked eye in identifying all four PGs during TT. The reduced risk of postoperative hypoparathyroidism and hypocalcemia reflected this preservation value. However, it was not associated with a change in the length of hospital stay. Although rare, the readmission rate due to hypocalcemia was similar across both methods.
摘要：
背景：在甲状腺全切除术（TT）中使用近红外自发荧光（NIRAF）的额外益处仍存在争议。这项研究调查了NIRAF是否改善了术后患者的预后。
方法：我们分析了1711例TT患者，在九项随机对照试验中报道，在对五个数据库进行系统搜索之后。将NIRAF与护理标准(有/没有白光的裸眼)进行比较。结果包括甲状旁腺（PG）和钙参数以及其他临床结果。对于二分法的结果，计算对数比值比(logOR)，对于连续的结果，测量粗平均差(MD)。当异质性显著时进行敏感性分析。使用修订后的Cochrane偏倚风险工具评估方法学质量。
结果：与护理标准相比，NIRAF的使用与术后甲状旁腺功能减退的显著减少相关[logOR=-0.31;95%CI:-0.57:-0.05],意外去除PG[logOR=-0.93;95%CI:-1.60:-0.26],术后低钙血症[logOR=-0.43mmol/L;95%CI:-0.77:-0.09]。它还与术后PTH水平显著升高相关[MD=4.78pg/mL;95%CI:2.13:7.43],PG识别率[logOR=1.02；95%CI：0.31：1.72]，术后血清钙[MD=0.05；95%CI：0.00：0.09]，和手术时间[MD=9.38分钟；95％CI：6.68：12.09]。PG自体移植未见差异，住院时间,和因低钙血症而住院。七个试验的风险较低，其余的有一些担忧。
结论：在甲状腺全切除术中，NIRAF在识别所有四个甲状旁腺方面优于肉眼。术后甲状旁腺功能减退和低钙血症的风险降低反映了这种保存价值。然而,这与住院时间的变化无关.虽然罕见，两种方法的低钙血症再入院率相似.
方法：我们分析了1711例TT患者，在九项随机对照试验中报道，在对五个数据库进行系统搜索之后。将NIRAF与护理标准(有/没有白光的裸眼)进行比较。结果包括甲状旁腺（PG）和钙参数以及其他临床结果。对于二分法的结果，计算对数比值比(logOR)，对于连续的结果，测量粗平均差(MD)。当异质性显著时进行敏感性分析。使用修订后的Cochrane偏倚风险工具评估方法学质量。
结果：与护理标准相比，NIRAF的使用与术后甲状旁腺功能减退的显著减少相关[logOR=-0.31;95%CI:-0.57:-0.05],意外去除PG[logOR=-0.93;95%CI:-1.60:-0.26],术后低钙血症[logOR=-0.43mmol/L;95%CI:-0.77:-0.09]。它还与术后PTH水平显著升高相关[MD=4.78pg/mL;95%CI:2.13:7.43],PG识别率[logOR=1.02；95%CI：0.31：1.72]，术后血清钙[MD=0.05；95%CI：0.00：0.09]，和手术时间[MD=9.38分钟；95％CI：6.68：12.09]。PG自体移植未见差异，住院时间,和因低钙血症而住院。七个试验的风险较低，其余的有一些担忧。
结论：在甲状腺全切除术中，NIRAF在识别所有四个甲状旁腺方面优于肉眼。术后甲状旁腺功能减退和低钙血症的风险降低反映了这种保存价值。然而,这与住院时间的变化无关.虽然罕见，两种方法的低钙血症再入院率相似.
