背景:术后甲状旁腺功能减退常发生在甲状腺全切除术(TT)后。这项研究的目的是调查是否使用近红外自发荧光(NIRAF)的甲状旁腺(PG)可以帮助有经验的外科医生在手术期间识别更多的PG,可能减少意外切除,并评估其对术后甲状旁腺功能减退的影响。
方法:所有患者至少接受两名有经验的外科医生的TT,在2020年至2021年期间,我们纳入研究对象,并随机分为两个队列:NIRAF组(NG)和对照组(CG).短暂性甲状旁腺功能减退症定义为术后第1天的血清PTH浓度<12ng/mL,永久性定义为手术后第6个月需要钙活性维生素D治疗,但仍无法检测到PTH或<12ng/m。
结果:在236例患者中(NG中的111例,125inCG),NG中识别的PG数量较高(93.9%,417/444)与CG(81.4%,407/500)(p<0.001),NG和CG的平均每个患者为3.76±0.44PG。意外切除的PG的数量在NG中为14,在CG中为42(p<0.0001)。在NG的18例患者(16.2%)和CG的40例患者(32.0%)中观察到了暂时性甲状旁腺功能减退(p=0.004)。永久性甲状旁腺功能减退影响NG的1例患者和CG的7例患者(p=0.06)。与CG(85.5±40.62分钟)相比,NG(104.3±32.08分钟)的平均手术时间更长(p<0.001)。
结论:NIRAF增强了PG的识别,防止其意外切除并降低术后甲状旁腺功能减退症的总体发生率。
BACKGROUND: Post-surgical hypoparathyroidism often occurs after total thyroidectomy (TT). The aim of this study is to investigate whether the use of near-infrared autofluorescence (NIRAF) of parathyroid glands (PGs) can aid experienced surgeons in identifying more PGs during surgery, potentially reducing unintended resection, and assessing its impact on post-surgical hypoparathyroidism.
METHODS: All patients undergoing at least a TT by two experienced surgeons, between 2020 and 2021, were enrolled and randomized into two cohorts: NIRAF group (NG) and CONTROL group (CG). Transient hypoparathyroidism was defined by serum concentration of PTH<12 ng/mL at the 1st post-operative day and permanent by the need of calcium-active vitamin D treatment >6 months from the surgery with still undetectable PTH or <12 ng/m.
RESULTS: Among 236 patients (111 in NG, 125 in CG), the number of PGs identified was higher in NG (93.9%, 417/444) compared to CG (81.4%, 407/500) (p < 0.001), with a mean of 3.76 ± 0.44 PGs per patient in NG and 3.25 ± 0.79 in CG. The number of unintendedly resected PGs was 14 in NG and 42 in CG (p < 0.0001). Transient hypoparathyroidism was observed in 18 patients (16.2%) in NG and 40 patients (32.0%) in CG (p = 0.004). Permanent hypoparathyroidism affected 1 patient in NG and 7 patients in CG (p = 0.06). The mean operative time was longer in NG (104.3 ± 32.08 min) compared to CG (85.5 ± 40.62 min) (p < 0.001).
CONCLUSIONS: NIRAF enhances the identification of PGs, preventing their inadvertent resection and reducing the overall incidence of post-surgical hypoparathyroidism.