吲哚菁绿荧光血管造影术用于定量评估全甲状腺切除术后原位甲状旁腺的灌注和功能

Indocyanine green fluorescence angiography for quantitative evaluation of in situ parathyroid gland perfusion and function after total thyroidectomy.

作者信息

Lang Brian Hung-Hin, Wong Carlos K H, Hung Hing Tsun, Wong Kai Pun, Mak Ka Lun, Au Kin Bun

机构信息

Division of Endocrine Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.

Department of Family Medicine and Primary Care, University of Hong Kong, 3/F Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong SAR, China.

出版信息

Surgery. 2017 Jan;161(1):87-95. doi: 10.1016/j.surg.2016.03.037. Epub 2016 Nov 10.

DOI:10.1016/j.surg.2016.03.037

PMID:27839936

Abstract

BACKGROUND

Because the fluorescent light intensity on an indocyanine green fluorescence angiography reflects the blood perfusion within a focused area, the fluorescent light intensity in the remaining in situ parathyroid glands may predict postoperative hypocalcemia risk after total thyroidectomy.

METHODS

Seventy patients underwent intraoperative indocyanine green fluorescence angiography after total thyroidectomy. Any parathyroid glands with a vascular pedicle was left in situ while any parathyroid glands without pedicle or inadvertently removed was autotransplanted. After total thyroidectomy, an intravenous 2.5 mg indocyanine green fluorescence angiography was given and real-time fluorescent images of the thyroid bed were recorded using the SPY imaging system (Novadaq, Ontario, Canada). The fluorescent light intensity of each indocyanine green fluorescence angiography as well as the average and greatest fluorescent light intensity in each patient were calculated. Postoperative hypocalcemia was defined as adjusted calcium <2.00 mmol/L within 24 hours.

RESULTS

The fluorescent light intensity between discolored and normal-looking indocyanine green fluorescence angiographies was similar (P = .479). No patients with a greatest fluorescent light intensity >150% developed postoperative hypocalcemia while 9 (81.8%) patients with a greatest fluorescent light intensity ≤150% did. Similarly, no patients with an average fluorescent light intensity >109% developed PH while 9 (30%) with an average fluorescent light intensity ≤109% did. The greatest fluorescent light intensity was more predictive than day-0 postoperative hypocalcemia (P = .027) and % PTH drop day-0 to 1 (P < .001).

CONCLUSION

Indocyanine green fluorescence angiography is a promising operative adjunct in determining residual parathyroid glands function and predicting postoperative hypocalcemia risk after total thyroidectomy.

摘要

背景

由于吲哚菁绿荧光血管造影术中的荧光强度反映了聚焦区域内的血液灌注情况，因此保留原位的甲状旁腺中的荧光强度可能预测甲状腺全切除术后的低钙血症风险。

方法

70例患者在甲状腺全切除术后接受了术中吲哚菁绿荧光血管造影。任何有血管蒂的甲状旁腺都保留原位，而任何无蒂或意外切除的甲状旁腺则进行自体移植。甲状腺全切除术后，静脉注射2.5mg吲哚菁绿进行荧光血管造影，并使用SPY成像系统（加拿大安大略省诺瓦达科公司）记录甲状腺床的实时荧光图像。计算每次吲哚菁绿荧光血管造影的荧光强度以及每位患者的平均和最大荧光强度。术后低钙血症定义为术后24小时内校正钙<2.00mmol/L。

结果

变色与外观正常的吲哚菁绿荧光血管造影之间的荧光强度相似（P = 0.479）。最大荧光强度>150%的患者均未发生术后低钙血症，而最大荧光强度≤150%的患者中有9例（81.8%）发生了术后低钙血症。同样，平均荧光强度>109%的患者均未发生低钙血症，而平均荧光强度≤109%的患者中有9例（30%）发生了低钙血症。最大荧光强度比术后第0天低钙血症（P = 0.027）和第0天至第1天甲状旁腺激素下降百分比（P < 0.001）更具预测性。