Wang T, Liu Z, Zhang P Y, Qiu B, Liu C G, Yin D T
Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Key Discipline Laboratory of Clinical Medicine for Colleges and Universities in Henan, Zhengzhou 450052, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 May 7;55(5):490-496. doi: 10.3760/cma.j.cn115330-20191223-00773.
To evaluate the potential factors influencing the parathyroid autofluorescence intensity of near-infrared fluorescent (NIRF) and further value of NIRF in identifying the parathyroid during surgery. The clinical data of 51 patients who underwent thyroid or parathyroid surgery in the Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University from April to June 2019 were retrospectively analyzed, including 16 males and 35 females, aged 18 to 74 years.The fluorescence intensity (FI) of the parathyroid glands, thyroid glands and background, and the number of parathyroid glands detected by NIRF and white light were measured. Variance analysis, two independent samples test and Spearman rank correlation analysis were used to analyze the relationship between standardized parathyroid FI and clinical variables. Chi square test was used to analyze the difference of parathyroid detection rate between NIRF and white light. In the 51 patients, the mean standardized parathyroid FI was greater than the standardized thyroid FI (1.72 ± 0.68 1.25 ± 0.40, =6.555, <0.001). The standardized parathyroid FI was not associated with gender, age, operation type, BMI, preoperative serum Ca(2+), parathyroid hormone and calcitonin (all >0.05), but it was associated with disease type (=2.636, <0.05). The mean standardized parathyroid FI of SHPT was lower than that of PTC, PTC with nodular goiter or NG(0.70±0.28 1.86±0.70, 1.69±0.49, 1.64±0.44, value was 3.023, -1.129,-2.019, respectively, all <0.05). There was no difference in the standardized parathyroid FI between SHPT and PHPT (1.34±0.18, =1.218, 0.05). There was no difference in standardized parathyroid FI between PHPT, PTC, NG, and PTC with NG(all >0.05). Except for 3 cases of SHPT, 117 parathyroid glands were detected by NIRF and 101 parathyroid glands were detected by white light. The detection rate of parathyroid glands detected by NIRF was higher than that detected by white light (98.32% 84.87%, χ(2)=13.974, <0.001). In SHPT, the detection rate of parathyroid gland by NIRF was 25.00%. Except SHPT, parathyroid FI is not affected by other clinical variables. NIRF can improve the detection rate of parathyroid glands during operation.
评估影响近红外荧光（NIRF）甲状旁腺自发荧光强度的潜在因素以及NIRF在手术中识别甲状旁腺的进一步价值。回顾性分析2019年4月至6月在郑州大学第一附属医院甲状腺外科接受甲状腺或甲状旁腺手术的51例患者的临床资料，其中男性16例，女性35例，年龄18至74岁。测量甲状旁腺、甲状腺及背景的荧光强度（FI），以及通过NIRF和白光检测到的甲状旁腺数量。采用方差分析、两独立样本t检验和Spearman等级相关分析来分析标准化甲状旁腺FI与临床变量之间的关系。采用卡方检验分析NIRF与白光下甲状旁腺检出率的差异。在51例患者中，甲状旁腺平均标准化FI大于甲状腺标准化FI（1.72±0.68比1.25±0.40，t=6.555，P<0.001）。标准化甲状旁腺FI与性别、年龄、手术类型、BMI、术前血清Ca²⁺、甲状旁腺激素和降钙素均无关联（均P>0.05），但与疾病类型有关（χ²=2.636，P<0.05）。SHPT的甲状旁腺平均标准化FI低于PTC、结节性甲状腺肿合并PTC或单纯结节性甲状腺肿（0.70±0.28比1.86±0.70、1.69±0.4,9、1.64±0.44，t值分别为3.023、-1.129、-2.019，均P<0.05）。SHPT与PHPT的标准化甲状旁腺FI无差异（1.34±0.18，t=1.218，P>0.05）。PHPT、PTC、结节性甲状腺肿、结节性甲状腺肿合并PTC之间的标准化甲状旁腺FI无差异（均P>0.05）。除3例SHPT外，NIRF检测到117个甲状旁腺，白光检测到101个甲状旁腺。NIRF检测甲状旁腺的检出率高于白光（98.32%比84.87%，χ²=13.974，P<0.001）。在SHPT中，NIRF检测甲状旁腺的检出率为25.00%。除SHPT外，甲状旁腺FI不受其他临床变量影响。NIRF可提高手术中甲状旁腺的检出率。
