Department of Otorhinolaryngology-Head and Neck Surgery, Inje University College of Medicine, Busan Paik Hospital, Busan, South Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Kosin University Gospel Hospital, Busan, South Korea.
Thyroid. 2021 Sep;31(9):1400-1408. doi: 10.1089/thy.2021.0056. Epub 2021 Jun 4.
Near-infrared autofluorescence (NIRAF) imaging is known to reduce the incidence of post-thyroidectomy hypocalcemia. However, there are no studies on how much NIRAF imaging affects the serum parathyroid hormone (PTH) level after surgery. We investigated the changes of the serum PTH level and ionized calcium (iCa.) in patients undergoing total thyroidectomy with central neck dissection (CND). This retrospective study with historical control enrolled 542 patients who underwent total thyroidectomy with CND. Patients were divided into two groups: the NIRAF group (261 patients) and the control group (281 patients). PTH and iCa. levels were measured at the hospital stay, 1, 3, and 6 months after surgery. In addition, the number of identified parathyroid glands (PGs), autotransplanted PGs, and the inadvertent resection rate of PGs was evaluated. The incidence of postoperative hypoparathyroidism (PTH <15 pg/mL) was significantly lower in the NIRAF group during the hospitalization (88 patients: 33.7% vs. 131 patients: 46.6%; = 0.002) and at 1 month postoperatively (23 patients: 8.8% vs. 53 patients: 18.9%; = 0.001). There was no difference in the permanent hypoparathyroidism rate (6 months after surgery) between the NIRAF group and the control group (4.2% vs. 4.6%; = 0.816). There was no difference in the incidence of hypocalcemia (iCa. <1.09 mmol/L) (during hospitalization: 6.5% vs. 10.0%; 1 month: 2.3% vs. 2.5%; 3 months: 0.8% vs. 0.7%; 6 months after surgery: 1.1% vs. 1.1%) between the two groups. The number of inadvertently resected PGs was significantly lower in the NIRAF group (18:6.9% vs. 36:12.8%; = 0.021). These results suggest that NIRAF imaging may reduce temporary hypoparathyroidism and the risk of inadvertent resection of PGs in patients undergoing total thyroidectomy with CND.
近红外荧光（NIRAF）成像已被证实可降低甲状腺切除术后低钙血症的发生率。然而，目前尚无研究探讨 NIRAF 成像对术后甲状旁腺激素（PTH）水平的影响程度。我们研究了接受中央颈部清扫术（CND）的甲状腺全切除术患者的血清 PTH 水平和离子钙（iCa）的变化。
这项回顾性研究采用历史对照，共纳入 542 例接受 CND 的甲状腺全切除术患者。患者分为两组：NIRAF 组（261 例）和对照组（281 例）。在术后住院期间、术后 1、3 和 6 个月时测量 PTH 和 iCa 水平。此外，还评估了甲状旁腺（PG）的数量、自体移植 PG 数量以及意外切除 PG 的比率。
NIRAF 组在住院期间（88 例：33.7% vs. 131 例：46.6%；=0.002）和术后 1 个月（23 例：8.8% vs. 53 例：18.9%；=0.001）的术后甲状旁腺功能减退症（PTH <15 pg/mL）发生率显著较低。NIRAF 组与对照组之间（6 个月时）永久性甲状旁腺功能减退症的发生率无差异（4.2% vs. 4.6%；=0.816）。两组之间低钙血症（iCa <1.09 mmol/L）的发生率（住院期间：6.5% vs. 10.0%；1 个月：2.3% vs. 2.5%；3 个月：0.8% vs. 0.7%；6 个月：1.1% vs. 1.1%）无差异。NIRAF 组无意中切除的 PG 数量明显较少（18 例：6.9% vs. 36 例：12.8%；=0.021）。
这些结果表明，NIRAF 成像可能会降低接受 CND 的甲状腺全切除术患者的暂时性甲状旁腺功能减退症和意外切除 PG 的风险。
