吲哚菁绿荧光血管造影术可指导甲状旁腺手术中的术中定位。
Indocyanine Green Fluorescence Angiography Can Guide Intraoperative Localization During Parathyroid Surgery.
机构信息
Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School "A. Moro" of Bari, Bari, Italy.
Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
出版信息
Scand J Surg. 2021 Mar;110(1):59-65. doi: 10.1177/1457496919877581. Epub 2019 Sep 25.
BACKGROUND AND AIMS
Intraoperative localization of pathologic parathyroid glands is of major importance for the hyperparathyroidism treatment. Based on the small size and the anatomic variability, the localization can be very challenging. The current practice is to compare preoperative ultrasonography with Technetium-99m sestamibi scintigraphy (MIBI) and plan the resection accordingly. In this study, we implemented indocyanine green angiography for the intraoperative localization of parathyroid glands.
MATERIALS AND METHODS
This is a retrospective analysis of 37 patients with primary, secondary, or tertiary hyperparathyroidism who were operated using indocyanine green angiography for the intraoperative localization of pathological parathyroid glands. An indocyanine green solution of 2.5 mg was were intravenously administered for parathyroid gland visualization. Different fluorescence scores were correlated with changes in postoperative parathyroid hormone levels.
RESULTS
Patients were divided into two groups depending on the presence of uniglandular or multiglandular disease. Sixty-four lesions were resected, and the final histopathologic analysis confirmed the parathyroid origin in 62 of them (96.8%). None of the patients with uniglandular disease developed postoperative hypoparathyroidism, whereas three patients in the multiglandular group developed temporary hypoparathyroidism symptoms. Indocyanine green imaging had higher sensitivity for the intraoperative detection of parathyroid glands compared with ultrasonography and MIBI ( < 0.001).
CONCLUSION
Indocyanine green angiography indicated high sensitivity for the intraoperative identification of pathologic parathyroid glands leading to a resection rate of 95.16%. The modality was useful, especially in cases of revisional surgery or ectopic parathyroid glands. Randomized trials have already proven the value of indocyanine green imaging in predicting postoperative hypocalcemia. Our results support the regular use of this method during parathyroid surgery.
背景与目的
甲状旁腺病理腺体的术中定位对于甲状旁腺功能亢进症的治疗至关重要。由于甲状旁腺体积小且解剖结构多变，定位可能极具挑战性。目前的做法是将术前超声与锝 99m 甲氧基异丁基异腈（MIBI）扫描进行比较，并据此计划切除。在这项研究中，我们使用吲哚菁绿血管造影术进行术中甲状旁腺定位。
材料和方法
这是一项回顾性分析，纳入了 37 例原发性、继发性或三发性甲状旁腺功能亢进症患者，这些患者在手术中使用吲哚菁绿血管造影术定位病理性甲状旁腺。静脉内给予 2.5mg 的吲哚菁绿溶液以可视化甲状旁腺。不同的荧光评分与术后甲状旁腺激素水平的变化相关。
结果
根据是否存在单腺或多腺病变，患者被分为两组。共切除了 64 个病灶，其中 62 个（96.8%）最终经组织病理学分析证实为甲状旁腺起源。无一例单腺病变患者发生术后甲状旁腺功能减退症，而多腺病变组中有 3 例患者出现暂时性甲状旁腺功能减退症状。与超声和 MIBI 相比，吲哚菁绿成像在术中检测甲状旁腺方面具有更高的敏感性（<0.001）。
结论
吲哚菁绿血管造影术对术中识别病理性甲状旁腺具有较高的敏感性，切除率为 95.16%。该方法特别适用于再次手术或异位甲状旁腺的情况。随机试验已经证明了吲哚菁绿成像在预测术后低钙血症方面的价值。我们的结果支持在甲状旁腺手术中常规使用这种方法。
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