The impact of near infrared fluorescence imaging on parathyroid function after total thyroidectomy
The impact of near infrared fluorescence imaging on parathyroid function after total thyroidectomy
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DOI：
10.1002/jso.26098
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发表时间：
2020-06-29
影响因子：
2.5
通讯作者：
Berber, Eren
中科院分区：
文献类型：
--
作者：
Kim, Yoo Seok;Erten, Ozgun;Berber, Eren
背景 与传统甲状腺切除术相比，据报道，利用近红外荧光成像（NIFI）进行甲状腺全切除术（TT）后低钙血症发生率较低。本研究的目的是评估 NIFI 对 TT 术后甲状旁腺功能的影响。方法 这是一项经机构审查委员会批准的回顾性研究，比较了同一位外科医生在 NIFI 指导下接受 TT 治疗的 100 名患者和未接受 NIFI 指导的 200 名患者。使用chi(2)和t检验比较临床参数。结果 术中发现的甲状旁腺平均数量在两组之间相似。然而，尽管自体移植率相似（分别为 4% 和 6%）（P = .562），但传统组（14%）的偶发甲状旁腺切除率高于 NIFI 组（6%）（P = .039）。传统组和 NIFI 组之间短暂性（6.5% vs 5.0%）和永久性（0.5% vs 0%）低钙血症的发生率没有统计学差异（P = NS）。结论 在甲状腺切除术中使用 NIFI 可以提高外科医生通过荧光对比识别甲状旁腺的能力，从而降低偶发甲状旁腺切除术的发生率。然而，与最近文献报道相反，与传统技术相比，术后低钙血症发生率没有改变，这表明甲状旁腺脉管系统的保留，而不是增强检测腺体的能力，可能主要影响术后功能。
Background Compared with conventional thyroidectomy, hypocalcemia rate was reported to be lower after total thyroidectomy (TT) utilizing near infrared fluorescence imaging (NIFI). The aim of this study is to evaluate the impact of NIFI on postoperative parathyroid function after TT. Methods This was a retrospective institutional review board-approved study comparing 100 patients who underwent TT with NIFI guidance and 200 patients without, by the same surgeon. Clinical parameters were compared using chi(2)andttest. Results Average number of parathyroid glands identified intraoperatively was similar between two groups. However, rate of incidental parathyroidectomy was higher in conventional (14%) versus NIFI group (6%) (P = .039), despite similar (4% vs 6%, respectively) autotransplantation rates (P = .562). Incidences of transient (6.5% vs 5.0%) and permanent (0.5% vs 0%) hypocalcemia were not statistically different between conventional and NIFI groups (P = NS). Conclusion The use of NIFI during thyroidectomy may decrease the rate of incidental parathyroidectomy by increasing the ability of the surgeon to recognize parathyroid glands with fluorescent contrast distinction. Nevertheless, in contrary to recent reports in literature, postoperative hypocalcemia rate was not altered compared with conventional technique, suggesting that preservation of parathyroid vasculature, rather than an augmented ability to detect the glands, may dominantly affect postoperative function.