Identifying Parathyroids in Pediatric Thyroid/Parathyroid Surgery by Near Infrared Autofluorescence.
Identifying Parathyroids in Pediatric Thyroid/Parathyroid Surgery by Near Infrared Autofluorescence.
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通过近红外自发荧光识别小儿甲状腺/甲状旁腺手术中的甲状旁腺。
DOI：
10.1002/lary.30633
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Mahadevan-Jansen,Anita
中科院分区：
文献类型：
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作者：
Belcher,RyanH;Thomas,Giju;Willmon,ParkerA;Gallant,Jean-Nicolas;Baregamian,Naira;Lopez,MonicaE;Solόrzano,CarmenC;Mahadevan-Jansen,Anita
目的与接受甲状腺手术的成人患者相比，儿童患者甲状旁腺功能减退症的发生率较高，通常与甲状旁腺 (PG) 无意损伤或血管断流有关。先前的研究表明，近红外自发荧光（NIRAF）可以在术中可靠地用于无标记甲状旁腺识别，但所有先前的研究都是在成年患者中进行的。在本研究中，我们评估了 NIRAF 的实用性和准确性，该系统采用基于光纤探针的系统来识别接受甲状腺切除术或甲状旁腺切除术的儿科患者中的 PG。方法所有接受甲状腺切除术或甲状旁腺切除术的儿科患者（18 岁以下）均参加了这项 IRB 批准的研究。首先记录外科医生对组织的视觉评估，并记录外科医生对所识别组织的置信度。然后使用光纤探头以 785nm 的波长照射感兴趣的组织，并在外科医生不知道结果的情况下测量这些组织产生的 NIRAF 强度。结果在 19 名儿科患者的术中测量了 NIRAF 强度。 PG 的标准化 NIRAF 强度 (3.63±±2.47) 显着高于甲状腺 (0.99±±0.36,p<±0.001) 和其他周围软组织 (0.86±±0.40,p<±0.001)。基于 PG 识别率阈值 1.2，NIRAF 的检出率为 95.8%（46/48 儿科 PG）。结论我们的研究结果表明，NIRAF 检测可能是一种有价值的非侵入性技术，可在儿科人群颈部手术期间识别 PG。据我们所知，这是第一项针对儿童的研究，旨在评估基于探头的 NIRAF 检测在术中甲状旁腺识别中的准确性。证据级别 4 级喉镜，133：3208–3215，2023
ObjectivesCompared to adult patients undergoing thyroid surgery, pediatric patients have higher rates of hypoparathyroidism often related to parathyroid gland (PG) inadvertent injury or devascularization. Previous studies have shown that near‐infrared‐autofluorescence (NIRAF) can be reliably used intraoperatively for label‐free parathyroid identification, but all prior studies have been performed in adult patients. In this study, we assess the utility and accuracy of NIRAF with a fiber‐optic probe‐based system to identify PGs in pediatric patients undergoing thyroidectomy or parathyroidectomy.MethodsAll pediatric patients (under 18 years of age) undergoing thyroidectomy or parathyroidectomy were enrolled in this IRB‐approved study. The surgeon's visual assessment of tissues was first noted and the surgeon's confidence level in the tissue identified was recorded. A fiber‐optic probe was then used to illuminate tissues‐of‐interest with a wavelength of 785 nm and resulting NIRAF intensities from these tissues were measured while the surgeon was blinded to results.ResultsNIRAF intensities were measured intraoperatively in 19 pediatric patients. Normalized NIRAF intensities for PGs (3.63 ± 2.47) were significantly higher than that of thyroid (0.99 ± 0.36,p< 0.001) and other surrounding soft tissues (0.86 ± 0.40,p< 0.001). Based on the PG identification ratio threshold of 1.2, NIRAF yielded a detection rate of 95.8% (46/48 pediatric PGs).ConclusionOur findings indicate that NIRAF detection can potentially be a valuable and non‐invasive technique to identify PGs during neck operations in the pediatric population. To our knowledge, this is the first study in children to assess the accuracy of probe‐based NIRAF detection for intraoperative parathyroid identification.Level of EvidenceLevel 4Laryngoscope, 133:3208–3215, 2023