Chirurgia (Bucur). 2023 Jun;118(3):291-301. doi: 10.21614/chirurgia.2023.v.118.i.3.p.291.
The main postoperative complications of thyroidectomy are hypoparathyroidism and recurrent laryngeal nerve (RLN) palsy. Methylene blue, which is a drug and dye, is safe and easy to get, and we can use it to avoid complications during thyroidectomy. Objectives: We aim to assess that we can spray Methylene blue to allow the identification of important structures intraoperative which are the parathyroid gland and recurrent laryngeal nerve. Also, to evaluate that this technique is safe, effective, technically feasible, and less dangerous than other techniques. Our study is a prospective cohort study of patients, patients who presented with simple nodular goiter, solitary thyroid nodule, controlled toxic goiter, and failed medical treatment with the indication for thyroidectomy, suspected malignancy, and retrosternal goiters at El-Demerdash Hospital from the period of August 2021 to August 2022. In the specified study period of 1 year from 1/8/2021 to 31/7/2022. Sixty patients underwent thyroidectomy 54 underwent total while 6 only underwent hemithyroidectomy. The time taken to wash out the dye over the thyroid gland was 15 to 25 minutes, the parathyroid gland was 4 to 7 minutes and the recurrent laryngeal nerve (RLN) was almost 0 to 1 minute and this indicated that the RLN almost did not take the dye. In the controlled group, two patients had symptoms and signs of hypocalcemia only one of them had signs of tetany, 8 patients had laboratory hypocalcemia, two patients suffered from a change of voice and another two patients suffered difficulty breathing one of which needed temporary tracheostomy while in the interventional group, only one patient had symptoms and signs of hypocalcemia no one had signs of tetany, two patients had laboratory hypocalcemia, one patient suffered from the change of voice and another two patients suffered the difficulty of breathing but no one needed a tracheostomy tube. It is safe, useful, and suitable to use Methylene blue spraying to keep the parathyroid gland and RLN during thyroidectomy, which led us to reduce the percentage of incidence of postoperative complications. Also, it helped us to find the parathyroid gland and RLN during the surgery, despite some surgeons seeing that searching for the parathyroid and RLN can lead to harmful effects and increase the incidence of injury.
甲状腺切除术的主要术后并发症是甲状旁腺功能减退和喉返神经（RLN）麻痹。亚甲蓝是一种药物和染料，安全且易于获得，我们可以用它来避免甲状腺切除术的并发症。目的：我们旨在评估是否可以喷洒亚甲蓝，以在术中识别甲状旁腺和喉返神经等重要结构。此外，评估该技术是安全、有效、技术可行且比其他技术危害小。
我们的研究是对在 El-Demerdash 医院就诊的患者进行的前瞻性队列研究，这些患者患有单纯性结节性甲状腺肿、单发甲状腺结节、控制良好的毒性甲状腺肿和经药物治疗失败且有甲状腺切除术指征、疑似恶性肿瘤和胸骨后甲状腺肿的患者。研究时间为 2021 年 8 月至 2022 年 8 月。在 2021 年 8 月 1 日至 2022 年 7 月 31 日的指定 1 年研究期间，共有 60 名患者接受了甲状腺切除术，其中 54 名患者接受了全甲状腺切除术，6 名患者仅接受了甲状腺叶切除术。冲洗甲状腺上的染料的时间为 15 至 25 分钟，甲状旁腺为 4 至 7 分钟，喉返神经（RLN）几乎为 0 至 1 分钟，这表明 RLN 几乎没有摄取染料。在对照组中，有 2 名患者出现低钙血症的症状和体征，其中仅 1 名患者出现抽搐体征，8 名患者出现实验室低钙血症，2 名患者出现声音改变，另有 2 名患者出现呼吸困难，其中 1 名需要临时气管切开，而在干预组中，仅有 1 名患者出现低钙血症的症状和体征，无抽搐体征，2 名患者出现实验室低钙血症，1 名患者出现声音改变，另有 2 名患者出现呼吸困难，但无患者需要气管切开管。
喷洒亚甲蓝安全、有效，适用于甲状腺切除术时保护甲状旁腺和 RLN，可以降低术后并发症的发生率。此外，它还有助于我们在手术中找到甲状旁腺和 RLN，尽管一些外科医生认为寻找甲状旁腺和 RLN可能会导致有害影响并增加损伤的发生率。
