Moreno Llorente Pablo, García Barrasa Arantxa, Francos Martínez José Manuel, Alberich Prats Marta, Pascua Solé Mireia
Unidad de Cirugía Endocrina. Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), C/ Feixa Llarga s/n, 08907, Barcelona, Spain.
World J Surg. 2022 Jan;46(1):121-127. doi: 10.1007/s00268-021-06322-x. Epub 2021 Sep 24.
We compared the reliability of indocyanine green (ICG) angiography and intraoperative PTH levels for predicting early post-thyroidectomy hypocalcemia.
Prospective study of 94 patients (71% women, mean age 53.7 years) undergoing total thyroidectomy. An ICG score of 2 (white) indicated a well-vascularized gland. PTH preoperative levels-PTH postresection levels divided by preoperative PTH × 100 was used to determine the PTH decline percentage. A decrease of at least 62.5% or <17.1 pg/mL in ioPTH was the criterion for predicting hypocalcemia.
At surgery, the four parathyroid glands were identified in 50 (53.2%) patients and <4 glands in 44. Calcium supplements were needed by 22 patients (23.4%) postoperatively, 11 patients in each group of 4 and <4 parathyroid glands identified. The diagnostic accuracy of ICG angiography (0.883, 95% confidence interval [CI] 0.800-0.940) and ioPTH (0.862, 95% CI 0.775-0.92) was similar. When all four parathyroid glands were identified, ICG angiography showed a slightly higher diagnostic accuracy, specificity and positive predictive than ioPTH levels, but when < 4 glands were identified, the ioPTH showed a slightly higher diagnostic accuracy, specificity and positive predictive value. Differences were not statistically significant for any of the comparisons.
The presence of one well-perfused parathyroid gland (ICG score 2) using ICG angiography or ioPTH decline, measured before and after completion of thyroid surgery, is both reliable methods in prediction of early post-thyroidectomy hypocalcemia independently of the number of glands identified intraoperatively.
我们比较了吲哚菁绿（ICG）血管造影和术中甲状旁腺激素（PTH）水平对预测甲状腺切除术后早期低钙血症的可靠性。
对94例行甲状腺全切除术的患者（71%为女性，平均年龄53.7岁）进行前瞻性研究。ICG评分为2（白色）表明腺体血运良好。用（术前PTH水平 - 切除术后PTH水平）除以术前PTH×100来确定PTH下降百分比。术中PTH下降至少62.5%或<17.1 pg/mL是预测低钙血症的标准。
手术中，50例（53.2%）患者的四个甲状旁腺被识别出，44例患者的甲状旁腺少于4个。术后22例患者（23.4%）需要补钙，甲状旁腺被识别出4个和少于4个的两组中各有11例。ICG血管造影（0.883，95%置信区间[CI] 0.800 - 0.940）和术中PTH（0.862，95% CI 0.775 - 0.92）的诊断准确性相似。当四个甲状旁腺均被识别出时，ICG血管造影的诊断准确性、特异性和阳性预测值略高于术中PTH水平，但当甲状旁腺少于4个时，术中PTH的诊断准确性、特异性和阳性预测值略高。所有比较的差异均无统计学意义。
使用ICG血管造影或甲状腺手术前后测量的术中PTH下降情况，存在一个血运良好的甲状旁腺（ICG评分为2），是预测甲状腺切除术后早期低钙血症的可靠方法，与术中识别出的甲状旁腺数量无关。
