Department of Surgery, Ludwig Maximilians University Munich, Innenstadt Medical Campus, Nussbaumstrasse 20, 80336 Munich, Germany.
Department of Obstetrics and Gynecology, Ludwig Maximilians University Munich, Maistr. 11, 80337 Munich, Germany.
Molecules. 2019 Jul 14;24(14):2560. doi: 10.3390/molecules24142560.
Injury to parathyroid glands during thyroid and parathyroid surgery is common and postoperative hypoparathyroidism represents a serious complication. Parathyroid glands possess a unique autofluorescence in the near-infrared spectrum which could be used for their identification and protection at an early stage of the operation. In the present study parathyroid autofluorescence was visualized intraoperatively using a standard Storz laparoscopic near-infrared/indocyanine green (NIR/ICG) imaging system with minor modifications to the xenon light source (filtered to emit 690 nm to 790 nm light, less than 1% in the red and green above 470 nm and no blue light). During exposure to NIR light parathyroid tissue was expected to show autofluorescence at 820 nm, captured in the blue channel of the camera. Over a period of 5 years, we investigated 205 parathyroid glands from 117 patients. 179 (87.3%) glands were correctly identified by their autofluorescence. Surrounding structures such as thyroid, lymph nodes, muscle, or adipose tissue did not reveal substantial autofluorescence. We conclude that parathyroid glands can be identified by their unique autofluorescence at an early stage of the operation. This may help to preserve these fragile structures and their vascularization and lower the rate of postoperative hypocalcemia.
在甲状腺和甲状旁腺手术中损伤甲状旁腺是很常见的，术后甲状旁腺功能减退症是一种严重的并发症。甲状旁腺在近红外光谱中具有独特的自发荧光，这可用于在手术早期识别和保护它们。在本研究中，我们使用标准的史托斯腹腔镜近红外/吲哚菁绿（NIR/ICG）成像系统，对氙光源进行了微小的修改（过滤后发射 690nm 到 790nm 的光，在 470nm 以上的红光和绿光中少于 1%，没有蓝光），术中可视化甲状旁腺的自发荧光。在暴露于近红外光下时，甲状旁腺组织预计会在 820nm 处显示自发荧光，在相机的蓝色通道中捕获。在 5 年的时间里，我们研究了 117 名患者的 205 个甲状旁腺。通过它们的自发荧光，179 个（87.3%）腺体被正确识别。甲状腺、淋巴结、肌肉或脂肪组织等周围结构没有明显的自发荧光。我们得出结论，甲状旁腺可以通过其在手术早期的独特自发荧光来识别。这可能有助于保护这些脆弱的结构及其血管化，降低术后低钙血症的发生率。
