Assessing Intraoperative Laser Speckle Contrast Imaging of Parathyroid Glands in Relation to Total Thyroidectomy Patient Outcomes
Assessing Intraoperative Laser Speckle Contrast Imaging of Parathyroid Glands in Relation to Total Thyroidectomy Patient Outcomes
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DOI：
10.1089/thy.2021.0093
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发表时间：
2021-08-18
期刊：
影响因子：
6.6
通讯作者：
Mahadevan-Jansen, Anita
中科院分区：
文献类型：
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作者：
Mannoh, Emmanuel A.;Thomas, Giju;Mahadevan-Jansen, Anita
背景：在甲状腺切除术中，准确评估甲状旁腺血管分布对于保护甲状旁腺功能和预防术后低钙血症非常重要。激光散斑对比成像 (LSCI) 已被证明可以准确检测甲状旁腺血管分布的差异。在这项外科医生盲法预后研究中，我们评估了甲状腺全切除术患者术中 LSCI 测量与术后结果之间的关系。方法：本研究纳入 72 名甲状腺切除患者。甲状腺切除后，使用 LSCI 设备对所有已识别的甲状旁腺进行成像，并计算每个甲状旁腺的散斑对比度值。计算每位患者的平均值，并根据术后第 1 天 (POD1) 测量的患者甲状旁腺激素 (PTH) 水平是否正常 (16-77 pg/mL) 或低水平对数据进行分组。本研究的目的是建立一个斑点对比度阈值，用于将甲状旁腺分类为充分灌注，并确定术后正常甲状旁腺功能需要多少个此类腺体。结果：斑点对比度限值为 0.186，将正常甲状旁腺组和甲状旁腺功能减退组区分开来，敏感性为 87.5%，特异性为 84.4%：POD1 上 PTH 较低的 8 名患者中，有 7 名的平均甲状旁腺斑点对比度高于此限值，而术后 PTH 正常的 64 名患者中，有 54 例的平均甲状旁腺斑点对比度低于此限值。以此值作为甲状旁腺灌注充足的阈值，确定术后甲状旁腺功能正常只需要1个血管化腺体：69例至少有1个血管化腺体（由LSCI确定）的患者中，64例（92.8%）术后PTH正常，而所有3例无血管化腺体的患者（100%）术后PTH均较低。总体而言，本研究中暂时性和永久性甲状旁腺功能减退症的发生率分别为 8.3% 和 1.4%。结论：LSCI 是一种有前途的评估甲状旁腺血管分布的技术。它有可能通过在手术期间为外科医生提供额外信息来帮助保留甲状旁腺功能，从而帮助减少甲状腺切除术后低钙血症的发生率。
Background: Accurate assessment of parathyroid gland vascularity is important during thyroidectomy to preserve the function of parathyroid glands and to prevent postoperative hypocalcemia. Laser speckle contrast imaging (LSCI) has been shown to be accurate in detecting differences in parathyroid vascularity. In this surgeon-blinded prognostic study, we evaluate the relationship between intraoperative LSCI measurements and postoperative outcomes of total thyroidectomy patients. Methods: Seventy-two thyroidectomy patients were included in this study. After thyroid resection, an LSCI device was used to image all parathyroid glands identified, and a speckle contrast value was calculated for each. An average value was calculated for each patient, and the data were grouped according to whether the patient had normal (16-77 pg/mL) or low levels of parathyroid hormone (PTH) measured on postoperative day 1 (POD1). The aim of this study was to establish a speckle contrast threshold for classifying a parathyroid gland as adequately perfused and to determine how many such glands are required for normal postoperative parathyroid function. Results: A speckle contrast limit of 0.186 separated the normoparathyroid and hypoparathyroid groups with 87.5% sensitivity and 84.4% specificity: 7 of 8 patients with low PTH on POD1 had an average parathyroid speckle contrast above this limit, while 54 of 64 patients with normal postoperative PTH had an average parathyroid speckle contrast below this limit. Taking this value as the threshold for adequate parathyroid perfusion, it was determined that only one vascularized gland was needed for normal postoperative parathyroid function: 64 of 69 patients (92.8%) with at least one vascularized gland (determined by LSCI) had normal postoperative PTH, while all 3 patients (100%) with no vascularized glands had low postoperative PTH. Overall, the rates of temporary and permanent hypoparathyroidism in this study were 8.3% and 1.4%, respectively. Conclusions: LSCI is a promising technique for assessing parathyroid gland vascularity. It has the potential to help reduce the incidence of hypocalcemia after thyroidectomy by providing surgeons with additional information during surgery to aid in the preservation of parathyroid function.