Kepez State Hospital, Department of General Surgery, Antalya, Turkey.
Trakya University Medical Faculty, Department of Endocrinology and Metabolism, Edirne, Turkey.
Photodiagnosis Photodyn Ther. 2020 Dec;32:102028. doi: 10.1016/j.pdpdt.2020.102028. Epub 2020 Oct 16.
Indocyanine green fluorescence (ICG) angiography has been used for many purposes including as part of a focused parathyroidectomy technique. Concomitant fluorescence of thyroid tissue may cause challenges defining parathyroid tissue during surgery, since ICG is not a selective fluorescent agent. On the other hand, cosmesis is still a big problem for patients due to the visible neck scars produced by the standard surgical technique. In this study, we described a novel technique to solve both these handicaps.
Seven patients who underwent ICG fluorescence angiography-guided transoral endoscopic thyroidectomy and parathyroidectomy vestibular approach between February 2018 and July 2019 were included. Serum parathyroid hormone (PTH) levels were measured intraoperatively and on postoperative day 1. Fluorescent images were confirmed with intraoperative quick-PTH levels.
All operations were done successfully without conversion to open surgery. Intense and isolated parathyroid fluorescent images were achieved in all operations. All patients had a 50 % decrease between the baseline and final quick-PTH levels and the final quick-PTH levels were in the normal range in all. One of 7 patients had epistaxis due to nasotracheal intubation. One of 7 patients had seroma on post-operative day 5. None of patients had mental nerve injury, permanent hypocalcemia and temporary or permanent recurrent laryngeal nerve injury.
ICG-guided transoral endoscopic thyroid and parathyroid surgery can be used in select patients to increase operative success in focused parathyroidectomy with excellent cosmetic outcome also noted.
吲哚菁绿荧光（ICG）血管造影术已被广泛应用于多种领域，包括作为甲状旁腺切除术的一部分。甲状腺组织的荧光共染可能会在手术中对甲状旁腺组织的定义造成挑战，因为 ICG 不是一种选择性荧光剂。另一方面，由于标准手术技术会在颈部产生可见的疤痕，因此美容问题仍然是患者的一大难题。在本研究中，我们描述了一种新的技术来解决这两个问题。
2018 年 2 月至 2019 年 7 月期间，我们对 7 例接受 ICG 荧光血管造影引导的经口内镜甲状腺和甲状旁腺切除术前庭入路的患者进行了研究。术中及术后第 1 天测量甲状旁腺激素（PTH）水平。通过术中快速 PTH 水平确认荧光图像。
所有手术均成功完成，无中转开放手术。所有手术均获得强烈且孤立的甲状旁腺荧光图像。所有患者的基线与最终快速 PTH 水平之间的降幅均为 50%，所有患者的最终快速 PTH 水平均在正常范围内。7 例患者中有 1 例因经鼻气管插管出现鼻出血。7 例患者中有 1 例在术后第 5 天出现血清肿。无患者出现喉上神经损伤、永久性低钙血症、暂时性或永久性喉返神经损伤。
ICG 引导的经口内镜甲状腺和甲状旁腺手术可用于选择患者，提高聚焦甲状旁腺切除术的手术成功率，同时也可获得良好的美容效果。
