First Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Minimal Invasive Endocrine Surgery, Interbalkan Medical Center, Thessaloniki, Greece.
Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece..
Endocr Pract. 2020 Sep;26(9):967-973. doi: 10.4158/EP-2020-0119.
Postoperative hypoparathyroidism (hypoPT) still remains a significant complication after thyroidectomy. Intra-operative imaging modalities, such as near-infrared fluorescence using indocyanine green (ICG), may assist in identifying and preserving the parathyroid glands (PGs). The purpose of this study was to test the association between the intra-operative ICG staining scoring system and 24-hour postoperative parathyroid hormone (PTH) levels, as well as its capability for intra-operative PG identification.
This was a prospective study, recruiting patients scheduled for total thyroidectomy by the same surgical team, from December 2018 to April 2019. Intra-operative angiography was performed after infusion of ICG solution (5 mg). Two minutes later, images were acquired using the near-infrared system.
Sixty patients fulfilled the eligibility criteria. The percentage of temporary postoperative hypoPT (defined as PTH <14 pg/mL) was 11.66%. No association between intra-operative ICG staining score (expressed as the number of PGs scoring <2 per patient) and 24-hour postoperative PTH (r = 0.011; P = .933) or serum calcium concentrations (r = 0.127; P = .335) was observed. There was also no correlation between the location of PGs scoring ≤2 and postoperative PTH (P = .257) or serum calcium levels (P = .950). Moreover, with regard to secondary endpoint, ICG correctly identified PGs in 98.3% of cases. ICG score was not affected by age, gender, duration of operation, or thyroid gland pathology. No allergic reactions attributed to ICG administration were observed.
The intra-operative ICG staining scoring system did not predict 24-hour postoperative PTH and serum calcium levels. However, this modality may assist in intra-operative PG identification during a total thyroidectomy.
甲状腺切除术后的甲状旁腺功能减退症（简称 hypoPT）仍然是一种严重的并发症。术中成像方式，如使用吲哚菁绿（ICG）的近红外荧光，可以帮助识别和保留甲状旁腺（PGs）。本研究旨在检验术中 ICG 染色评分系统与术后 24 小时甲状旁腺激素（PTH）水平之间的相关性，并评估其在术中识别 PG 的能力。
这是一项前瞻性研究，于 2018 年 12 月至 2019 年 4 月间，由同一手术团队招募计划行甲状腺全切除术的患者。在注入 ICG 溶液（5mg）后进行术中血管造影，两分钟后使用近红外系统采集图像。
60 名患者符合入选标准。暂时性术后 hypoPT（定义为 PTH<14pg/mL）的发生率为 11.66%。术中 ICG 染色评分（表示每个患者评分<2 的 PG 数量）与术后 24 小时的 PTH（r=0.011；P=0.933）或血清钙浓度（r=0.127；P=0.335）之间无相关性。PG 评分≤2 的位置与术后 PTH（P=0.257）或血清钙水平（P=0.950）之间也无相关性。此外，对于次要终点，ICG 在 98.3%的情况下正确识别了 PG。ICG 评分不受年龄、性别、手术时间或甲状腺病理的影响。未观察到与 ICG 给药相关的过敏反应。
术中 ICG 染色评分系统不能预测术后 24 小时的 PTH 和血清钙水平。然而，这种方法可能有助于甲状腺全切除术中识别 PG。
