Department of Surgery, University of California San Diego, San Diego, CA.
Department of Surgery, University of California San Diego, San Diego, CA.
Surgery. 2018 Feb;163(2):388-392. doi: 10.1016/j.surg.2017.08.018. Epub 2017 Nov 10.
Our aim was to evaluate the ease and utility of using indocyanine green fluorescence angiography for intraoperative localization of the parathyroid glands.
Indocyanine green fluorescence angiography was performed during 60 parathyroidectomies for primary hyperparathyroidism during a 22-month period. Indocyanine green was administered intravenously to guide operative navigation using a commercially available fluorescence imaging system. Video files were graded by 3 independent surgeons for strength of enhancement using an adapted numeric scoring system.
There were 46 (77%) female patients and 14 (23%) male patients whose ages ranged from 17 to 87 (average 60) years old. Of the 60 patients, 43 (71.6%) showed strong enhancement, 13 (21.7%) demonstrated mild to moderate vascular enhancement, and 4 (6.7%) exhibited little or no vascular enhancement. Of the 54 patients who had a preoperative sestamibi scan, a parathyroid adenoma was identified in 36, while 18 failed to localize. Of the 18 patients who failed to localize, all 18 patients (100%) had an adenoma that fluoresced on indocyanine green imaging. The operations were performed safely with minimal blood loss and short operative times.
Indocyanine green angiography has the potential to assist surgeons in identifying parathyroid glands rapidly with minimal risk.
我们旨在评估使用吲哚菁绿荧光血管造影术术中定位甲状旁腺的简便性和实用性。
在 22 个月的时间里，对 60 例原发性甲状旁腺功能亢进症患者进行了 60 例甲状旁腺切除术，术中进行了吲哚菁绿荧光血管造影术。静脉内给予吲哚菁绿，使用市售的荧光成像系统引导手术导航。视频文件由 3 名独立外科医生根据改良数字评分系统对增强强度进行分级。
46 例（77%）为女性患者，14 例（23%）为男性患者，年龄 17-87 岁，平均年龄 60 岁。60 例患者中，43 例（71.6%）显示强烈增强，13 例（21.7%）显示轻度至中度血管增强，4 例（6.7%）显示血管增强微弱或无。54 例患者术前行 sestamibi 扫描，其中 36 例发现甲状旁腺瘤，18 例未定位。在未能定位的 18 例患者中，所有患者（100%）均有腺瘤在吲哚菁绿成像时荧光。手术安全进行，出血量少，手术时间短。
吲哚菁绿血管造影术具有帮助外科医生快速识别甲状旁腺的潜力，风险极小。
