Serra Carlos, Silveira Luís, Canudo António
Department of Surgery, SAMS Hospital, Lisbon, Portugal.
Health Sciences Research Centre (CICS-UBI), University of Beira Interior, Covilhã, Portugal.
Gland Surg. 2020 Aug;9(4):893-898. doi: 10.21037/gs-20-163.
Incidental excision of parathyroid glands is a common event during thyroid surgery and in spite the divergent results that can be obtained from the literature about its clinical significance, all efforts must be used to their preservation. Due to the autofluorescence emitted by parathyroid glands, authors began to use a custom device to inspect thyroidectomy specimens for incidentally removed parathyroid tissue; the results of using this device are presented in this manuscript.
Specimens of 40 consecutive thyroid surgeries were inspected. Localization of suspect high-fluorescence spots were recorded for confirmation with a pathological exam. Determinations of calcium and parathyroid hormone (PTH) were completed prior to surgery and at 24 hours and 15 days after the operation.
Patient age ranged from 36 to 83 years and were predominantly female (82.5%). Calcium values at 24 hours post-operation varied between 7.1 and 9.5. The PTH values ranged between 3 and 77. Thirteen patients (32.5%) presented with biochemical hypocalcemia at 24 hours. At 15 days after the operation, only one patient presented with a calcium value below 8 (PTH: 10.9) with complete normalization 6 months after the surgery. Pathological examination identified eight parathyroid fragments in seven patients. There was no correlation between the presence of parathyroid tissue in the specimen and post-operative hypocalcemia (P=0.254). Eight suspicious areas of augmented fluorescence where detected; seven were coincident with the pathological examination and one was a false positive. One intrathyroidal gland was not identified, resulting a sensitivity of 87.5% and specificity 96.2%.
Although no correlation between incidental parathyroidectomy and hypocalcemia was demonstrated, autofluorescence may be a useful tool for in-table identification of incidentally-removed glands.
甲状旁腺的意外切除是甲状腺手术中的常见情况，尽管关于其临床意义的文献结果存在分歧，但仍应尽一切努力保留甲状旁腺。由于甲状旁腺发出的自发荧光，作者开始使用定制设备检查甲状腺切除标本中意外切除的甲状旁腺组织；本文介绍了使用该设备的结果。
对连续40例甲状腺手术的标本进行检查。记录可疑高荧光点的位置，以便通过病理检查进行确认。在手术前、术后24小时和15天完成钙和甲状旁腺激素（PTH）的测定。
患者年龄在36至83岁之间，以女性为主（82.5%）。术后24小时的钙值在7.1至9.5之间。PTH值在3至77之间。13例患者（32.5%）在术后24小时出现生化性低钙血症。术后15天，只有1例患者的钙值低于8（PTH：10.9），术后6个月完全恢复正常。病理检查在7例患者中发现了8个甲状旁腺碎片。标本中甲状旁腺组织的存在与术后低钙血症之间无相关性（P=0.254）。检测到8个荧光增强的可疑区域；7个与病理检查结果一致，1个为假阳性。1个甲状腺内甲状旁腺未被识别，灵敏度为87.5%，特异性为96.2%。
虽然未证明意外甲状旁腺切除与低钙血症之间存在相关性，但自发荧光可能是术中识别意外切除甲状旁腺的有用工具。
