St. Paul's Hospital Department of Surgery, The University of British Columbia Department of Surgery , Vancouver, British Columbia, Canada.
Biomedical Engineering, University of British Columbia , Vancouver, British Columbia, Canada.
Expert Rev Endocrinol Metab. 2020 Nov;15(6):439-457. doi: 10.1080/17446651.2020.1831913. Epub 2020 Oct 19.
The parathyroid glands (PGs) are critical for calcium regulation and homeostasis. The preservation of PGs during neck surgery is crucial to avoid postoperative hypoparathyroidism. There are no existing guidelines for intraoperative PG identification, and the current approach relies heavily on the experience of the operating surgeon. A technique that accurately and rapidly identifies PGs would represent a useful intraoperative adjunct.
This review aims to assess common dye and fluorescence-based PG imaging techniques and examine their utility for intraoperative PG identification. A literature search of published data on methylene blue (MB), indocyanine green (ICG) angiography, near-infrared autofluorescence (NIRAF), and the PGs between 1971 and 2020 was conducted on PubMed.
NIRAF and near-infrared (NIR) parathyroid angiography have emerged as promising and reliable techniques for intraoperative PG identification. NIRAF may aid with real-time identification of both normal and diseased PGs and reduce the risk of postoperative complications such as hypocalcemia. Further large prospective multicenter studies should be conducted in thyroid and parathyroid surgical patient populations to confirm the clinical efficacy of these intraoperative NIR-based PG detection techniques.
甲状旁腺（PGs）对钙的调节和稳态至关重要。在颈部手术中保留 PGs 对于避免术后甲状旁腺功能减退症至关重要。目前尚不存在术中 PG 识别的指南，目前的方法主要依赖于手术医生的经验。一种能够准确快速识别 PGs 的技术将是一种有用的术中辅助手段。
本综述旨在评估常见的染料和荧光 PG 成像技术，并研究它们在术中 PG 识别中的应用。在 PubMed 上对 1971 年至 2020 年间发表的关于亚甲蓝（MB）、吲哚菁绿（ICG）血管造影、近红外自发荧光（NIRAF）和 PG 的文献进行了检索。
NIRAF 和近红外（NIR）甲状旁腺血管造影术已成为术中 PG 识别的有前途和可靠的技术。NIRAF 可能有助于实时识别正常和患病的 PGs，并降低术后并发症（如低钙血症）的风险。应在甲状腺和甲状旁腺手术患者群体中进行进一步的大型前瞻性多中心研究，以确认这些基于 NIR 的术中 PG 检测技术的临床疗效。
