Randomized Controlled Trial Comparing White Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification During Total Thyroidectomy
Randomized Controlled Trial Comparing White Light with Near-Infrared Autofluorescence for Parathyroid Gland Identification During Total Thyroidectomy
复制标题
DOI：
10.1016/j.jamcollsurg.2018.12.044
复制
发表时间：
2019-05-01
影响因子：
5.2
通讯作者：
Rosenthal, Raul
中科院分区：
文献类型：
--
作者：
Dip, Fernando;Falco, Jorge;Rosenthal, Raul
背景技术背景：甲状旁腺在甲状腺全切除术中很难识别，意外切除会导致术后低钙血症。我们的主要目标是评估使用近红外光（NIRL）自体荧光术中甲状旁腺识别的有效性，并衡量其对术后低钙血症incidence.Study Design的影响：全甲状腺切除术进行了170例不同的甲状腺病理，块随机（1：1）成2个相等的组。在对照组中，始终使用传统的头顶白色光（WL）。实验组术前用NIRL增强甲状旁腺识别。比较对照组用WL与解剖前、实验组用NIRL、实验组用WL与解剖前甲状旁腺的数量。结果：术前NIRL检出甲状旁腺的平均数目与术后WL检出甲状旁腺的平均数目相同（3.5 vs 3.6）。在实验组中，从WL到NIRL的转换使检测到的腺体数量从2.6增加到3.5（p < 0.001），并且在67.1%的患者中揭示了至少1个先前遗漏的腺体。钙水平
BACKGROUND: Parathyroid glands are difficult to identify during total thyroidectomies, and accidental resection can lead to problematic postoperative hypocalcemia. Our main goals were to evaluate the effectiveness of using near-infrared light (NIRL) autofluorescence intraoperatively for parathyroid gland identification and to measure its impact on postoperative hypocalcemia incidence.STUDY DESIGN: Total thyroidectomies were performed on 170 patients with different thyroid pathologies, block-randomized (1: 1) into 2 equal groups. Among controls, traditional overhead white light (WL) was used throughout. In the experimental group, NIRL was used to enhance parathyroid gland recognition before thyroid dissection. The number of parathyroid glands identified was compared after thyroid dissection in controls using WL vs pre-dissection in the experimental using NIRL and with WL vs NIRL before thyroid dissection in the experimental group. Postoperative serum calcium levels and hypocalcemia rates were compared.RESULTS: The mean number of parathyroid glands identified pre-dissection with NIRL was the same identified post-dissection with WL (3.5 vs 3.6). In the experimental group, converting from WL to NIRL increased the number of glands detected from 2.6 to 3.5 (p < 0.001), and revealed at least 1 previously missed gland in 67.1% of patients. Calcium levels