Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education, Beijing, China.
Front Endocrinol (Lausanne). 2023 Jan 30;14:1086367. doi: 10.3389/fendo.2023.1086367. eCollection 2023.
Hypoparathyroidism is an important factor that seriously affects the quality of life of patients after thyroidectomy. This study aimed to optimize the surgical procedure for parathyroid identification using near-infrared autofluorescence (NIRAF) during thyroidectomy.
This was a prospective controlled study that included 100 patients with primary papillary thyroid carcinoma diagnosed in Beijing Tongren Hospital between June 2021 and April 2022 who were awaiting total thyroidectomy and bilateral neck dissection. The patients were randomly divided into an experimental group in whom step-by-step NIRAF imaging was used to identify parathyroid glands, and a control group in whom NIRAF was not used.
The number of parathyroid glands identified in the NIRAF group was higher than that in the control group (195 vs. 161, p=0.000, Z=-5.186). The proportion of patients with parathyroid glands inadvertently removed in the NIRAF group was lower than that in the control group (2.0% vs. 18.0%, respectively; p=0.008, χ 7.111). In the NIRAF group, we found that more than 95% of the superior parathyroid glands and more than 85% of the inferior parathyroid glands were identified before the dangerous phase, which was much higher than that in the control group. The incidences of temporary hypoparathyroidism, hypocalcemia, and symptomatic hypocalcemia were higher in the control group than those in the NIRAF group. On the first postoperative day, the average parathyroid hormone (PTH) level in the NIRAF group decreased to 38.1% of the preoperative level and that in the control group decreased to 20.0% of the preoperative level (p=0.000, Z=-3.547). On the third postoperative day, the PTH level in 74% of the patients in the NIRAF group recovered to normal levels, whereas it recovered in only 38% of the patients in the control group (p=0.000, χ 13.149). The PTH levels in all patients in the NIRAF group had recovered within 30 days after surgery, whereas one patient in the control group failed to return to the normal level 6 months after surgery and was diagnosed with permanent parathyroidism.
The step-by-step NIRAF parathyroid identification method can effectively locate the parathyroid gland and protect its function.
甲状旁腺功能减退症是甲状腺切除术后严重影响患者生活质量的重要因素。本研究旨在优化术中甲状旁腺识别的手术程序，使用近红外自体荧光（NIRAF）进行甲状腺切除术。
这是一项前瞻性对照研究，纳入了 2021 年 6 月至 2022 年 4 月在北京同仁医院诊断为原发性甲状腺乳头状癌并接受全甲状腺切除术和双侧颈部淋巴结清扫术的 100 例患者。患者随机分为实验组，使用逐步 NIRAF 成像识别甲状旁腺，对照组不使用 NIRAF。
NIRAF 组识别的甲状旁腺数量高于对照组（195 对 161，p=0.000，Z=-5.186）。NIRAF 组无意中切除甲状旁腺的患者比例低于对照组（2.0%对 18.0%；p=0.008，χ 7.111）。在 NIRAF 组，我们发现超过 95%的上甲状旁腺和超过 85%的下甲状旁腺在危险阶段之前被识别，这明显高于对照组。对照组暂时性甲状旁腺功能减退、低钙血症和症状性低钙血症的发生率高于 NIRAF 组。术后第 1 天，NIRAF 组甲状旁腺激素（PTH）水平平均降至术前水平的 38.1%，对照组降至术前水平的 20.0%（p=0.000，Z=-3.547）。术后第 3 天，NIRAF 组 74%的患者 PTH 水平恢复正常，而对照组仅 38%的患者恢复正常（p=0.000，χ 13.149）。NIRAF 组所有患者的 PTH 水平均在术后 30 天内恢复正常，而对照组有 1 例患者术后 6 个月未能恢复正常水平，被诊断为永久性甲状旁腺功能减退症。
逐步 NIRAF 甲状旁腺识别方法可有效定位甲状旁腺并保护其功能。
